Autologous Hematopoietic Stem Cell Transplantationfor Adult with Acute Leukemia in First Complete Remission

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 4447-4447
Author(s):  
Huifen Zhou ◽  
Wu Depei ◽  
Xiaowen Tang ◽  
Aining Sun ◽  
Zhengming Jin ◽  
...  
Keyword(s):  
Stem Cell ◽  
High Risk ◽  
Complete Remission ◽  
Acute Leukemia ◽  
Hematopoietic Stem Cell ◽  
Risk Group ◽  
Consolidation Chemotherapy ◽  
Moderate Risk ◽  
Hematopoietic Stem ◽  
First Complete Remission

Abstract Objective The objective of this study was to evaluate the clinical outcome of autologous hematopoietic stem cell transplantation (AHSCT) for acute leukemia(AL). Methods The outcome of 56 AL patients who received autologous HSCT(AHSCT) for AL in first complete remission (CR) from May 2001 to May 2008 were analyzed retrospectively. There were 31 males and 25 females, the median age was 25(11~ 57)years. The diagnosis of these patients were acute myeloid leukemia (AML, n=38), acute lymphocytic leukemia(ALL, n=17) and acute hybrid leukemia (AHL, n=1). Patients were divided into low/moderate risk group (n=46) and high risk group (n=10) according to their characteristics of newly diagnosis. If the patient achieved first complete remission(CR), one to three courses of intensification chemotherapy containing high dose cytarabine(HDAC)were given. All the patients were in CR1 before AHSCT. Stem cells were mobilized with MAG regimen which composed of HDAC, Mitoxantrone and G-CSF. The conditioning regimen consisted of modified BU/ CY for AML patients or total body irradiation (TBI) plus cyclophosphamide (CTX) for ALL patients. Patients received consolidation chemotherapy every 3 months after AHSCT until 3 years post transplant. Nine patients received several course of cytokine-induced killer (CIK) cells treatment. Result The median number of MNC and CD34 positive cell was 6.9(1.2 `21)×108/kg and 2.3(1.6 `6.3)×106/kg respectively. All patients achieved hemopoietc recovery. The median time of the engraftment of neutrophil and platelet was 9.7(8 `14) days and 12.9(9 `20) days posttransplant respectively. The incidence and severity of regimen-related toxicity were mild. The incidence of treatment related mortality (TRM)is 0%. The median follow-up of surviving patients was 31 months(range, 2 `86). Until now 46 patients are still alive, including 4 relapse cases. 13 cases were died of relapse. The five-year overall survival(OS) and the leukemia-free survival(LFS) were 77.3% and 71.9% respectively. The incidence of relapse was 23.2%. The OS and LFS in the low /moderate risk and high risk AL cohorts were 85.7%versus 40% and 79%versus 40% respectively(P<0.01) Conclusion AHSCT is the first option for the AL patients who were in good or moderate risk group and had achieved first complete remission. Regular consolidation chemotherapy after transplantation was beneficial to improve the LFS of AL patients.

Haploidentical Hematopoietic Stem Cell Transplantation with Treosulfan-Based Conditioning Regimen for Acute Leukemia Relapsing after Initial Allogeneic Transplantation

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 3956-3956
Author(s):  
Jacopo Peccatori ◽  
Lara Crucitti ◽  
Raffaella Greco ◽  
Maria Teresa Lupo Stanghellini ◽  
Luca Vago ◽  
...  
Keyword(s):  
Stem Cell ◽  
Hematopoietic Stem Cell Transplantation ◽  
Complete Remission ◽  
Stem Cell Transplantation ◽  
Acute Leukemia ◽  
Cell Transplantation ◽  
Hematopoietic Stem Cell ◽  
Disease Status ◽  
Disease Recurrence ◽  
Hematopoietic Stem

Abstract Background. Patients who experienced leukemia relapse after allogeneic hematopoietic stem cell transplantation (HSCT) have a dismal prognosis. Strategies to prevent or overcome post-transplant disease recurrence are limited and their efficacy still remains unclear. Recently, HSCT using haploidentical T-replete source has found increasing feasibility and acceptance thanks to new transplant platforms (Luznik L. et al., Biol Blood Marrow Transplant, 2008; Peccatori J. et al., Leukemia, 2014), allowing lower rates of graft-versus-host disease (GvHD) and non-relapse mortality (NRM). We evaluated the outcome of haploidentical transplant approach performed as second transplant (HSCT2) for patients who suffered of acute leukemia (AL) relapse after a first allogeneic HSCT (HSCT1). Methods. We analyzed 42 consecutive patients (median age 48 years) who underwent HSCT2 from a haploidentical donor, different from the previous one, between 2007 and 2013 in our Institute. Patients suffered of acute myeloid leukemia (n=31), acute lymphoblastic leukemia (n=9) or biphenotypic AL (n=2) relapsing after HSCT1 (matched related: 21; unrelated: 17; mismatched related: 4; umbilical cord blood: 4). Thirty-seven patients (88%) received re-induction therapy before HSCT2: 13 of them achieved complete remission (CR), 16 did not respond and 8 patients were transplanted directly in aplasia. In 5 cases HSCT2 was performed without re-induction therapy, in active disease (AD). Median Hematopoietic Cell Transplant-Co-morbidity Index was 2 (range 0-6) at time of HSCT2. All patients received treosulfan (14 g/m2 for 3 days) and fludarabine (30 mg/m2 for 5 days) as part of preparative regimen for HSCT2; conditioning was intensified with total body irradiation (4 Gray) in 18 (43%) or with melphalan (70 mg/m2 for 2 days) in 6 patients (14%). GvHD prophylaxis consisted of mycophenolate mofetile and sirolimus combined with pre-transplant anty-thymocyte globuline (n=36) or with post-transplant cyclophosphamide (n=6). Unmanipulated peripheral blood stem cells were used as graft source in all cases. Results. Three out of 42 patients (7%) experienced early death in aplasia, while all the others achieved neutrophil engraftment (n=39, 93%), with no primary graft rejection. Complete remission of disease at day +30 was reached in 37 out of 39 evaluated cases (95%). Estimated overall survival (OS) and leukemia-free survival (LFS) (± SE) rates at 1 year from HSCT2 were 37% (± 8%) and 35% (± 7%), respectively (Figure 1A). One-year relapse incidence (± SE) amounted to 32% (± 7%) and NRM (± SE) to 31% (± 7%) (Figure 1A) (7 patients died for infectious, 5 for GvHD and 1 for central nervous system toxicity). Sixteen patients (38%) experienced of acute GvHD grade II-IV and 20 (47%) of chronic GvHD. Disease status at HSCT2 (AD vs CR) had no impact on OS (HR:1.26, 95% CI 0.58-2.76, p=0.564) and relapse (HR:1.35, CI 95% 0.46-3.76, p=0.61). Conversely, time of remission from HSCT1>6 months provided the better outcome in terms of estimated OS (±SE) at 1 year (50% ± 10%) compared to patients with shorter duration of remission (18% ± 9%) (HR:0.49, 95% CI 0.24-1.02, p=0.05) and reduced risk of relapse (HR:0.28, 95% CI 0.11-0.75, p=0.011) (Figure 1B). After a median follow-up time of 22 months (range 6-68), 11 patients (26%) were alive with sustained leukemia remission. Conclusions. These results demonstrate the feasibility of HSCT2 from a haploidentical donor as treatment for AL relapse after initial allogeneic transplant, showing rates of OS, LFS and NRM comparable to the reported in literature for HSCT2 from matched related or unrelated graft, using the same or different donor (Christopeit M. et al., J Clin Oncol, 2013). Interestingly, disease status at HSCT2 did not influence the outcome of transplant. While, in accordance with previous reports, duration of remission after HSCT1 is the major factor involved in predicting outcome of a second transplant due to an increased relapse incidence after HSCT2 in patients with shorter HSCT1 remission, reflecting diseases biologically different. If confirmed in a larger cohort, these data could be useful in decision making after HSCT1 failure for disease recurrence. Disclosures Bonini: MolMed S.p.A.: Consultancy.

scholarly journals G-CSF-Primed Peripheral Blood Stem Cell Haploidentical Transplantation Could Achieve Satisfactory Clinical Outcomes for Acute Leukemia Patients in the First Complete Remission: A Registered Study

2021 ◽  
Vol 11 ◽  
Author(s):  
Yan-Ru Ma ◽  
Xiaohui Zhang ◽  
Lanping Xu ◽  
Yu Wang ◽  
Chenhua Yan ◽  
...  
Keyword(s):  
Stem Cell ◽  
Complete Remission ◽  
Acute Leukemia ◽  
Clinical Outcomes ◽  
Peripheral Blood ◽  
Chronic Gvhd ◽  
Unrelated Donor ◽  
Hematopoietic Stem ◽  
Haploidentical Transplantation ◽  
First Complete Remission

G-CSF-mobilized peripheral blood (G-PB) harvest is the predominant graft for identical sibling donor and unrelated donor allogeneic hematopoietic stem cell transplantation (HSCT) recipients, but it was controversial in haploidentical related donor (HID) HSCT. In this registry study, we aimed to identify the efficacy of HID G-PB HSCT (HID-PBSCT) for acute leukemia (AL) patients in first complete remission (CR1). Also, we reported the outcomes for the use of G-PB grafts in comparison with the combination of G-BM and G-PB grafts in HID HSCT recipients. Sixty-seven AL patients in CR1 who received HID-PBSCT were recruited at Institute of Hematology, Peking University. Patients who received haploidentical HSCT using the combination of G-BM and G-PB harvests in the same period were enrolled as controls (n=392). The median time from HSCT to neutrophil and platelet engraftment was 12 days (range, 9–19 days) and 12 days (range, 8–171 days), respectively. The 28-day cumulative incidence of neutrophil and platelet engraftment after HSCT was 98.5% and 95.5%, respectively. The cumulative incidences of grade II–IV and grade III–IV acute graft-versus-host disease (GVHD) were 29.9% (95%CI 18.8–40.9%) and 7.5% (95%CI 1.1–13.8%), respectively. The cumulative incidences of total and moderate-severe chronic GVHD were 54.9% (95%CI 40.9–68.8%) and 17.4% (95%CI 6.7–28.0%), respectively. The cumulative incidences of relapse and non-relapse mortality were 13.9% (95%CI 5.4–22.5%) and 3.4% (95%CI 0–8.1%), respectively. The probabilities of overall survival (OS) and leukemia-free survival (LFS) were 84.7% (95%CI 74.7–94.7%) and 82.7% (95%CI 73.3–92.1%) respectively. Compared with the HID HSCT recipients using the combination of G-BM and G-PB grafts, the engraftments of neutrophil and platelet were both significantly faster for the G-PB group, and the other clinical outcomes were all comparable between the groups. In multivariate analysis, graft types did not influence the clinical outcomes. Overall, for the patients with AL CR1, G-PB graft could be considered an acceptable graft for HID HSCT recipients. This study was registered at https://clinicaltrials.gov as NCT03756675.

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