Use of peripheral blood stem cells for autologous transplantation in acute myeloid leukemia patients allows faster engraftment and equivalent disease-free survival compared with bone marrow cells

Bone Marrow Transplant. 1999 Sep;24(5):467-72. doi: 10.1038/sj.bmt.1701920.

Abstract

We compared the feasibility and efficacy of autologous bone marrow (ABMT) and peripheral blood progenitor cell transplantation (PBSCT) performed after an identical induction/consolidation in adults with acute myeloid leukemia (AML). From January 1993 to June 1996 91 consecutive AML patients were enrolled in a program consisting of anthracycline-based induction and high-dose cytarabine consolidation (NOVIA). Until May 1994 ABMT was performed; from June 1994, if PBSC collection was adequate, PBSCT was performed. Out of 88 evaluable patients, 73 obtained a complete remission (CR) and 15 were resistant. Allogeneic bone marrow transplantation was performed in 16 patients. Forty-four (50%) were given autologous stem cell transplantation. ABMT was performed in 21 cases; twenty-nine patients were given G-CSF mobilization after NOVIA administration. An adequate number of PBSC was obtained in 23/29 (79%) cases, which were then re-infused. Median times to both neutrophil and platelet recovery from transplant were significantly shorter for the PBSC group (17 vs 36 days to 500 PMN/microl, P < 0.01; 20 vs 150 days to 20000 platelets/microl, P < 0.02; 37 vs 279 days to 50000 platelets/microl, P < 0.03), as were days of hospitalization after the reinfusion (18 vs 33, P < 0.03) and median days to transfusion independence. Toxicity was not significant in either group. After a minimum follow-up for live patients of 24 months (longer than the mean time for relapse observed for the PBSC series - 14 months) the percentage of relapses was similar: 11 of 21 (52.4%) and 12 of 23 (52.1%) in the ABMT and PBSC groups, respectively. Our results indicate that autologous PBSC transplantation, performed after an intensive chemotherapy regimen, is not inferior to ABMT in terms of disease-free survival and allows faster recovery times and reduced need for transfusion support.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease
  • Adult
  • Algorithms
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Blood Cells / transplantation*
  • Bone Marrow Transplantation*
  • Clinical Protocols
  • Combined Modality Therapy
  • Cytarabine / administration & dosage
  • Disease-Free Survival
  • Etoposide / administration & dosage
  • Evaluation Studies as Topic
  • Feasibility Studies
  • Female
  • Follow-Up Studies
  • Granulocyte Colony-Stimulating Factor / pharmacology
  • Hematopoietic Stem Cell Mobilization / methods
  • Hematopoietic Stem Cell Transplantation* / adverse effects
  • Humans
  • Idarubicin / administration & dosage
  • Leukapheresis
  • Leukemia, Myeloid / drug therapy
  • Leukemia, Myeloid / mortality
  • Leukemia, Myeloid / therapy*
  • Male
  • Middle Aged
  • Mitoxantrone / administration & dosage
  • Remission Induction
  • Time Factors
  • Transplantation, Autologous
  • Treatment Outcome

Substances

  • Cytarabine
  • Granulocyte Colony-Stimulating Factor
  • Etoposide
  • Mitoxantrone
  • Idarubicin

Supplementary concepts

  • ICE protocol 4
  • NOAC protocol