Autologous peripheral blood stem cell transplantation (PBSCT) in acute myeloid leukaemia (AML) in first complete remission (CR) a report of the BGMT cooperative group about 32 patients

Abstract

Thirty-two patients < 55 year with AML in first complete remission underwent autologous peripheral blood stem cell transplantation (PBSCT). Before transplant, they were treated with one or two induction courses plus one consolidation cycle including daunorubicin and araC. Thereafter, haemopoietic stem cells (HSC) were mobilized using daunorubicin 45 mg/m² days 1-3 plus either high-dose araC 3 g/m² TID, 4 days (BGMT87 trial, 13 patients) or intermediate-dose araC 500 mg/m² TID, 4 days and G-CSF from day 7 until completion of cytaphereses (BGMT91 trial, 19 patients). The median number of leukaphereses was 6 (range 5-6). Collections were better in the BGMT91 protocol concerning median MNC (18.1 versus 9.1 10⁸/kg, p 0.0019), median CFU-GM (36.5 versus 13.5 10⁴/kg, p 0.017), and median CD34+ cells (12.2 versus 7.65 10⁶/kg, p 0.24). The unpurged product was reinfused after busulfan 16 mg/kg and melphalan 140 mg/m². All but one patients engrafted. Number of days with fever and antibiotics, and hospitalization duration were significantly reduced in the BGMT91 protocol. No death in aplasia was encountered. The actuarial DFS at 3 years was 55%+/-18%. Sufficient HSC can be collected in AML following intensive consolidation and autologous PBSCT represents a valuable procedure in this setting.