title: Higher incidence of relapse in patients with acute myelocytic leukemia infused with higher doses of CD34+ cells from leukapheresis products autografted during the first remission.
abstract: The stem cell source for autologous transplantation has shifted from bone marrow to peripheral blood (PB). We previously showed that relapse incidence in patients with acute myelocytic leukemia autografted in first remission (CR1) was greater with PB than bone marrow, and a poorer outcome was associated with a shorter CR1 to PB transplantation interval (≤ 80 days). Leukemic and normal progenitors are CD34(+) and can be concomitantly mobilized; we assessed whether an association exists between the infused CD34(+) cell dose and outcome. The infused CD34(+) cell doses were available for 772 patients autografted more than 80 days after CR1 and were categorized by percentiles. We selected the highest quintile (> 7.16 × 10(6)/kg) as the cutoff point. By multivariate analysis, relapse was more probable in patients who received the highest dose (hazard ratio = 1.48; 95% confidence interval, 1.12-1.95; P = .005), and leukemia-free survival was worse (hazard ratio = 0.72; 95% confidence interval, 0.55-0.93; P = .01). In conclusion, in patients autografted in first remission, relapse was higher and leukemia-free survival lower for those who received the highest CD34(+) PB doses.
authors.affiliation: Department of Hematology, Hôpital Saint Antoine, 184 rue du Faubourg Saint-Antoine, Paris, France. Norbert-claude.gorin@sat.aphp.fr
authors.forename: Norbert-Claude
authors.initials: NC
authors.lastname: Gorin
authors.forename: Myriam
authors.initials: M
authors.lastname: Labopin
authors.forename: Josy
authors.initials: J
authors.lastname: Reiffers
authors.forename: Noel
authors.initials: N
authors.lastname: Milpied
authors.forename: Didier
authors.initials: D
authors.lastname: Blaise
authors.forename: Francis
authors.initials: F
authors.lastname: Witz
authors.forename: Theo
authors.initials: T
authors.lastname: de Witte
authors.forename: Giovanna
authors.initials: G
authors.lastname: Meloni
authors.forename: Michel
authors.initials: M
authors.lastname: Attal
authors.forename: Teresa
authors.initials: T
authors.lastname: Bernal
authors.forename: Vanderson
authors.initials: V
authors.lastname: Rocha
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D018952:Antigens, CD34 / Q000009:adverse effects*; D018572:Disease-Free Survival; D006801:Humans; D007937:Leukapheresis; D015470:Leukemia, Myeloid, Acute / Q000175:diagnosis / Q000188:drug therapy / Q000517:prevention & control* / Q000628:therapy*; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D012008:Recurrence; D012074:Remission Induction; D014182:Transplantation, Autologous; D055815:Young Adult
chemical_list: D018952:Antigens, CD34