High numbers of mobilized CD34+ cells collected in AML in first remission are associated with high relapse risk irrespective of treatment with autologous peripheral blood SCT or autologous BMT.
The faster hematopoietic recovery after autologous peripheral blood SCT (APBSCT) in patients with AML may be offset by an increased relapse risk as compared with autologous BMT (ABMT). The EORTC and GIMEMA Leukemia Groups conducted a trial (AML-10) in which they compared, as second randomization, APBSCT and ABMT in first CR patients without an HLA compatible donor. A total of 292 patients were randomized. The 5-year DFS rate was 41% in the APBSCT arm and 46% in the ABMT arm with a hazard ratio (HR) of 1.17; 95% confidence interval=0.85-1.59; P=0.34. The 5-year cumulative relapse incidence was 56% vs 49% (P=0.26), and the 5-year OS 50% and 55% (P=0.6) in the APBSCT and ABMT groups, respectively. APBSCT was associated with significantly faster recovery of neutrophils and platelets, shorter duration of hospitalization, reduced need of transfusion packed RBC and less days of intravenous antibiotics. In both treatment groups, higher numbers of mobilized CD34+ cells were associated with a significantly higher relapse risk irrespective of the treatment given after the mobilization. Randomization between APBSCT and ABMT did not result in significantly different outcomes in terms of DFS, OS and relapse incidence.
Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
M
M
Hengeveld
EORTC Headquarters, Brussels, Belgium.
S
S
Suciu
CHU, Lyon, France.
Y
Y
Chelgoum
Hôtel-Dieu, Paris, France.
J-P
JP
Marie
Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
P
P
Muus
Necker-Institut Curie, Paris, France.
F
F
Lefrère
Sapienza University, Roma, Italy.
F
F
Mandelli
Federico II University, Napoli, Italy.
F
F
Pane
Tor Vergata University Hospital, Roma, Italy.
S
S
Amadori
Ospedale Civile, Pescara, Italy.
G
G
Fioritoni
University Hospital Rebro, Zagreb, Croatia.
B
B
Labar
CHU Sart-Tilman, Liège, Belgium.
F
F
Baron
Institute Hematology, Prague, Czech Republic.
J
J
Cermak
Gustave Roussy Comprehensive Cancer Center, Villejuif, France.
J-H
JH
Bourhis
A.O.R.N. San Giuseppe Moscati, Avelino, Italy.
G
G
Storti
GIMEMA Data Center, Roma, Italy.
P
P
Fazi
Universitair Ziekenhuis Gasthuisberg, Leuven, Belgium.
A
A
Hagemeijer
GIMEMA Data Center, Roma, Italy.
M
M
Vignetti
Leiden University Medical Center, Leiden, The Netherlands.
R
R
Willemze
Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
T
T
de Witte
D000293:Adolescent; D000328:Adult; D018952:Antigens, CD34 / Q000378:metabolism*; D016026:Bone Marrow Transplantation / Q000379:methods*; D018572:Disease-Free Survival; D005260:Female; D019650:Hematopoietic Stem Cell Mobilization / Q000379:methods*; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000097:blood / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012074:Remission Induction; D012307:Risk Factors; D019172:Transplantation Conditioning / Q000379:methods*; D014182:Transplantation, Autologous; D055815:Young Adult
D018952:Antigens, CD34