Comparison of autologous and allogeneic hematopoietic stem cell transplantation for 140 patients with de novo acute leukemia in first complete remission.
- Author:
He-hua WANG
1
;
Si-zhou FENG
;
Mei WANG
;
Jia-lin WEI
;
Er-lie JIANG
;
Li ZHANG
;
Yong HUANG
;
Shi-yong ZHOU
;
Qing-guo LIU
;
Lu-gui QIU
;
Ming-zhe HAN
;
Wen-wei YAN
Author Information
- Publication Type:Journal Article
- MeSH: Acute Disease; Adolescent; Adult; Antineoplastic Combined Chemotherapy Protocols; therapeutic use; Bone Marrow Purging; Child; Combined Modality Therapy; Female; Hematopoietic Stem Cell Transplantation; methods; Humans; Immunotherapy; methods; Kaplan-Meier Estimate; Leukemia; therapy; Male; Middle Aged; Neoplasm Recurrence, Local; prevention & control; Remission Induction; Retrospective Studies; Transplantation Conditioning; methods; Transplantation, Autologous; Transplantation, Homologous; Treatment Outcome
- From: Chinese Journal of Hematology 2004;25(7):389-392
- CountryChina
- Language:Chinese
-
Abstract:
OBJECTIVETo evaluate the outcome of patients with de novo acute leukemia (AL, no AML-M(3)) in CR(1) undergone autologous hematopoietic stem cell transplantation (auto-HSCT) or HLA-identical sibling allogeneic HSCT (allo-HSCT).
METHODSForty-six AL patients received allo-HSCT and 94 received auto-HSCT in CR(1). The conditioning regimens mainly consisted of TBICy, BuCy and MAC. Cyclosporine plus methotrexate, or cyclosporine alone, or FK506 alone was used for graft-versus-host disease (GVHD) prophylaxis. Among auto-HSCT group, 39 patients received purged autologous bone marrow and 38 received immunotherapy and/or maintenance chemotherapy after transplant.
RESULTSMyeloid reconstitution was achieved in all patients. After a median of 700 (range, 18 approximately 5563) days follow-up, the probabilities of leukemia-free survival (LFS) at 5 year were not significantly different in these two groups: (51.5 +/- 5.4)% for auto-HSCT group and (52.8 +/- 7.6)% for allo-HSCT group (P > 0.05). There was a lower cumulative relapse incidence (RI) [(26.3 +/- 6.9)% vs. (52.0 +/- 5.5)%, P > 0.05] but a significantly higher cumulative transplant-related mortality (TRM) [(37.6 +/- 7.8% vs. (14.4 +/- 4.1)%, P < 0.05] in the allo-HSCT group than in auto-HSCT group. Among auto-HSCT group, the patients received purged autografts and/or post-transplant therapy had significantly better LFS and lower RI (P < 0.05) than those received unpurged autografts or no post-transplant treatments [5-y LFS: (62.8 +/- 6.8)% and (38.4 +/- 8.4)%; RI: (37.7 +/- 6.8)% and (74.2 +/- 8.7)%, respectively].
CONCLUSIONThe long-term LFS of auto-HSCT was comparable to that of allo-HSCT in the management of patients with AL in CR(1), because autograft purging and post-transplant treatment can significantly decrease relapse of auto-HSCT patients and auto-HSCT has lower therapy-related toxicities.
