Abstract
We studied the feasibility and efficacy of a two-step approach to Auto-SCT for patients with AML in second remission. Step 1 consisted of consolidation chemotherapy using cytarabine 2000 mg/m(2) i.v. every 12 h for 4 days plus etoposide 40 mg/kg total dose by continuous i.v. infusion over the same 4 days. PBSC were collected after G-CSF stimulation during recovery from this chemotherapy. Step 2, auto-SCT, used a preparative regimen of oral BU 16 mg/kg over 4 days followed by etoposide 60 mg/kg i.v. Of the 50 patients entered on Step 1, two died from treatment complications, and seven failed to proceed to transplantation. A median CD34+ cell dose of 5.9 x 10(6)/kg was collected in a median of three collections. With a median follow-up of 8.2 years, 5-year disease-free survival (DFS) is 28%. The most important prognostic factor was cytogenetics, with acute promyelocytic leukemia (APL) patients having a 5-year DFS of 67% compared with 16% for others. We conclude that this two-step approach to autologous transplantation produces good CD34+ mobilization and that this approach has cured some patients. Results in patients with APL are especially promising.
Publication types
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Multicenter Study
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Research Support, N.I.H., Extramural
MeSH terms
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Adult
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Aged
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Aging
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Antigens, CD34 / analysis
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Antimetabolites, Antineoplastic / administration & dosage
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Antimetabolites, Antineoplastic / adverse effects
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Antimetabolites, Antineoplastic / therapeutic use*
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Antineoplastic Agents, Phytogenic / administration & dosage
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Antineoplastic Agents, Phytogenic / adverse effects
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Antineoplastic Agents, Phytogenic / therapeutic use*
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Combined Modality Therapy / adverse effects
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Cytarabine / administration & dosage
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Cytarabine / adverse effects
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Cytarabine / therapeutic use*
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Disease-Free Survival
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Etoposide / administration & dosage
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Etoposide / adverse effects
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Etoposide / therapeutic use*
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Female
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Humans
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Ideal Body Weight
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Infusions, Intravenous
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Kaplan-Meier Estimate
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Leukemia, Myeloid, Acute / classification
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Leukemia, Myeloid, Acute / mortality
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Leukemia, Myeloid, Acute / therapy*
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Male
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Middle Aged
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Peripheral Blood Stem Cell Transplantation* / adverse effects
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Remission Induction
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Transplantation, Autologous
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Treatment Outcome
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Treatment Refusal
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Young Adult
Substances
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Antigens, CD34
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Antimetabolites, Antineoplastic
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Antineoplastic Agents, Phytogenic
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Cytarabine
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Etoposide