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.
Department of Hematology and Transplantation, Affiliated Hospital of Academy of Military Medical Sciences, Beijing, China.
Mei
M
Guo
Kai-Xun
KX
Hu
Chang-Lin
CL
Yu
Qi-Yun
QY
Sun
Jian-Hui
JH
Qiao
Dan-Hong
DH
Wang
Guang-Xian
GX
Liu
Wan-Jun
WJ
Sun
Li
L
Wei
Xue-Dong
XD
Sun
Ya-Jing
YJ
Huang
Jun-Xiao
JX
Qiao
Zheng
Z
Dong
Hui-Sheng
HS
Ai
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