Infusion of HLA-mismatched peripheral blood stem cells improves the outcome of chemotherapy for acute myeloid leukemia in elderly patients.
Treatment outcome of acute myeloid leukemia (AML) in elderly patients remains unsatisfactory. It has been shown that the infusion of granulocyte colony-stimulating factor-mobilized donor peripheral blood stem cells (G-PBSCs) can enhance graft-versus-leukemia effects and speed hematopoietic recovery. Fifty-eight AML patients aged 60-88 years were randomly assigned to receive induction chemotherapy with cytarabine and mitoxantrone (control group; n = 28) or it plus human leukocyte antigen-mismatched G-PBSCs (G-PBSC group; n = 30). Patients who achieved complete remission received another 2 cycles of postremission therapy with intermediate-dose cytarabine or it plus G-PBSCs. The complete remission rate was significantly higher in the G-PBSC group than in the control group (80.0% vs 42.8%; P = .006). The median recovery times of neutrophils and platelets were 11 days and 14.5 days, respectively, in the G-PBSC group and 16 days and 20 days, respectively, in the control group after chemotherapy. The 2-year probability of disease-free survival was significantly higher in the G-PBSC group than in the control group (38.9% vs 10.0%; P = .01). No graft-versus-host disease was observed in any patient. Persistent donor microchimerism was successfully detected in all of the 4 female patients. These results indicate that G-PBSCs in combination with conventional chemotherapy may provide a promising treatment method for AML in elderly patients.
Guo
Mei
M
Department of Hematology and Transplantation, Affiliated Hospital of Academy of Military Medical Sciences, Beijing, China.
Hu
Kai-Xun
KX
Yu
Chang-Lin
CL
Sun
Qi-Yun
QY
Qiao
Jian-Hui
JH
Wang
Dan-Hong
DH
Liu
Guang-Xian
GX
Sun
Wan-Jun
WJ
Wei
Li
L
Sun
Xue-Dong
XD
Huang
Ya-Jing
YJ
Qiao
Jun-Xiao
JX
Dong
Zheng
Z
Ai
Hui-Sheng
HS
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D003561:Cytarabine / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D006680:HLA Antigens / Q000276:immunology; D006648:Histocompatibility / Q000276:immunology; D006650:Histocompatibility Testing; D006801:Humans; D007239:Infections / Q000209:etiology; D007951:Leukemia, Myeloid / Q000276:immunology / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D008942:Mitoxantrone / Q000008:administration & dosage / Q000009:adverse effects; D036102:Peripheral Blood Stem Cell Transplantation / Q000379:methods*; D018183:Transplantation Chimera / Q000097:blood / Q000276:immunology; D016896:Treatment Outcome
D006680:HLA Antigens; D003561:Cytarabine; D008942:Mitoxantrone