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Autografting

Auto-SCT for AML in second remission: CALGB Study 9620

Bone Marrow Transplantation volume 44, pages 353–359 (2009)Cite this article

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/m2 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 × 106/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.

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References

  1. Gorin NC . Autologous stem cell transplantation in acute myelocytic leukemia. Blood 1998; 92: 1073–1090.

    CAS  PubMed  Google Scholar 

  2. Linker CA, Ries CA, Damon LE, Rugo HS, Wolf JL . Autologous bone marrow transplantation for acute myeloid leukemia using 4-hydroperoxycyclophosphamide-purged bone marrow and the busulfan/etoposide preparative regimen: a follow-up report. Bone Marrow Transplant 1998; 22: 865–872.

    Article  CAS  PubMed  Google Scholar 

  3. Linker CA, Damon LE, Ries CA, Navarro WA, Case D, Wolf JL . Autologous stem cell transplantation for advanced acute myeloid leukemia. Bone Marrow Transplant 2002; 29: 297–301.

    Article  CAS  PubMed  Google Scholar 

  4. Sanz MA, Labopin M, Gorin NC, de la Rubia J, Arcese W, Meloni G et al. Hematopoietic stem cell transplantation for adults with acute promyelocytic leukemia in the ATRA era: a survey of the European Cooperative Group for Blood and Marrow Transplantation. Bone Marrow Transplant 2007; 39: 461–469.

    Article  CAS  PubMed  Google Scholar 

  5. Lazarus HM, Perez WS, Klein JP, Kollman C, Bate-Boyle B, Bredeson CN et al. Autotransplantation versus HLA-matched unrelated donor transplantation for acute myeloid leukaemia: a retrospective analysis from the Center for International Blood and Marrow Transplant Research. Br J Haematol 2006; 132: 755–769.

    Article  PubMed  Google Scholar 

  6. Gorin NC, Labopin M, Fouillard L, Meloni G, Frassoni F, Iriondo A et al. Retrospective evaluation of autologous bone marrow transplantation vs allogeneic bone marrow transplantation from an HLA identical related donor in acute myelocytic leukemia. A study of the European Cooperative Group for Blood and Marrow Transplantation (EBMT). Bone Marrow Transplant 1996; 18: 111–117.

    CAS  PubMed  Google Scholar 

  7. Mollee P, Gupta V, Song K, Reddy V, Califaretti N, Tsang R et al. Long-term outcome after intensive therapy with etoposide, melphalan, total body irradiation and autotransplant for acute myeloid leukemia. Bone Marrow Transplant 2004; 33: 1201–1208.

    Article  CAS  PubMed  Google Scholar 

  8. Thomas X, Le Q, de Botton S, Raffoux E, Chelghoum Y, Pautas C et al. Autologous or allogeneic stem cell transplantation as post-remission therapy in refractory or relapsed acute myeloid leukemia after highly intensive chemotherapy. Leuk Lymphoma 2005; 46: 1007–1016.

    Article  CAS  PubMed  Google Scholar 

  9. Reiffers J, Labopin M, Sanz M, Korbling M, Blaise D, De La Rubia J et al. Autologous blood cell vs marrow transplantation for acute myeloid leukemia in complete remission: an EBMT retrospective analysis. Bone Marrow Transplant 2000; 25: 1115–1119.

    Article  CAS  PubMed  Google Scholar 

  10. Labopin M, Gorin NC . Autologous bone marrow transplantation in 2502 patients with acute leukemia in Europe: a retrospective study. Leukemia 1992; 6 (Suppl 4): 95–99.

    PubMed  Google Scholar 

  11. Harousseau J-L, Cahn J-Y, Pignon B, Witz F, Milpied N, Delain M et al. Comparison of autologous bone marrow transplantation and intensive chemotherapy as postremission therapy in adult acute myeloid leukemia. Blood 1997; 90: 2978–2986.

    CAS  PubMed  Google Scholar 

  12. Clopper CJ, Pearson ES . The use of confidence or fiducial limits illustrated in the case of the binomial. Biometrika 1934; 26: 404–413.

    Article  Google Scholar 

  13. Hajek J, Sidak Z, Sen PK . Theory of Rank Tests, 2nd edn. Academic Press: San Diego, CA, USA, 1999.

    Book  Google Scholar 

  14. Hothorn T, Hornik K, van de Wiel MA, Zeileis A . A LEGO system for conditional inference. Am Stat 2006; 60: 257–263.

    Article  Google Scholar 

  15. Agresti A . Categorical data analysis. Wiley: New York, NY, USA, 1990.

    Google Scholar 

  16. R Development Core Team. R: A Language and Environment for Statistical Computing. R Foundation for Statistical Computing: Vienna, Austria, 2006.

  17. Damon LE, Rugo HS, Ries CA, Linker CA . Delayed engraftment of 4-hydroperoxycyclophosphamide-purged autologous bone marrow after induction treatment containing mitoxantrone for acute myelogenous leukemia. Bone Marrow Transplant 1996; 17: 93–99.

    CAS  PubMed  Google Scholar 

  18. Linker CA, Ries CA, Damon LE, Sayre P, Navarro W, Rugo HS et al. Autologous stem cell transplantation for acute myeloid leukemia in first remission. Biol Blood Marrow Transplant 2000; 6: 50–57.

    Article  CAS  PubMed  Google Scholar 

  19. Nabhan C, Mehta J, Tallman MS . The role of bone marrow transplantation in acute promyelocytic leukemia. Bone Marrow Transplant 2001; 28: 219–226.

    Article  CAS  PubMed  Google Scholar 

  20. de Botton S, Fawaz A, Chevret S, Dombret H, Thomas X, Sanz M et al. Autologous and allogeneic stem-cell transplantation as salvage treatment of acute promyelocytic leukemia initially treated with all-trans-retinoic acid: a retrospective analysis of the European acute promyelocytic leukemia group. J Clin Oncol 2005; 23: 120–126.

    Article  CAS  PubMed  Google Scholar 

  21. Meloni G, Diverio D, Vignetti M, Avvisati G, Capria S, Petti MC et al. Autologous bone marrow transplantation for acute promyelocytic leukemia in second remission: prognostic relevance of pretransplant minimal residual disease assessment by reverse-transcription polymerase chain reaction of the PML/RAR alpha fusion gene. Blood 1997; 90: 1321–1325.

    CAS  PubMed  Google Scholar 

  22. Roman J, Martin C, Torres A, Jimenez MA, Andres P, Flores R et al. Absence of detectable PML-RAR alpha fusion transcripts in long-term remission patients after BMT for acute promyelocytic leukemia. Bone Marrow Transplant 1997; 19: 679–683.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

The research for CALGB 9620 was supported in part by grants from the National Cancer Institute (CA31946) to the Cancer and Leukemia Group B (Richard L Schilsky, MD, Chairman) and to the CALGB Statistical Center (Stephen George, PhD, CA33601). The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the National Cancer Institute.

The following institutions participated in this study:

Wake Forest University School of Medicine—David D Hurd, MD, supported by CA03927. University of California at San Francisco—Charles Ryan, MD, supported by CA60138. University of Chicago—Gini Fleming, MD, supported by CA41287. University of Maryland Cancer Center—Martin Edelman, MD, supported by CA31983. Duke University—Jeffrey Crawford, MD, supported by CA47577. North Shore University Hospital—Daniel R Budman, MD, supported by CA35279. Roswell Park Cancer Institute—Ellis Levine, MD, supported by CA02599. Washington University School of Medicine—Nancy Bartlett, MD, supported by CA77440. Mount Sinai School of Medicine—Lewis R Silverman, MD, supported by CA04457. Ohio State University Medical Center—Clara D Bloomfield, MD, supported by CA77658. State of New York Upstate Medical University—Stephen L Graziano, MD, supported by CA21060. University of North Carolina at Chapel Hill—Thomas C Shea, MD, supported by CA47559. Greenville CCOP, Cancer Centers of the Carolinas—Jeffrey K Giguere, MD, supported by CA29165. Medical University of South Carolina—Mark Green, MD, supported by CA03927. Southeast Cancer Control Consortium—James N Atkins, MD, supported by CA45808. University of Vermont—Hyman B Muss, MD, supported by CA77406. Weill Medical College of Cornell University—Scott Wadler, MD, supported by CA07968. Walter Reed Army Medical Center—Thomas Reid, MD, supported by CA26806.

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Authors and Affiliations

  1. Department of medicine, University of California, San Francisco, CA, USA

    C A Linker & L E Damon

  2. Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, USA

    K Owzar

  3. CALGB Statistical Center, Duke University Medical Center, Durham, NC, USA

    K Owzar & L E Archer

  4. Department of Medicine, Wake Forest University, Winston-Salem, NC, USA

    B Powell & D Hurd

  5. Department of Medicine, University of Chicago, Chicago, IL, USA

    R A Larson

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  1. C A Linker
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  2. K Owzar
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  4. D Hurd
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  7. R A Larson
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Cancer and Leukemia Group B

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Correspondence to C A Linker.

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Linker, C., Owzar, K., Powell, B. et al. Auto-SCT for AML in second remission: CALGB Study 9620. Bone Marrow Transplant 44, 353–359 (2009). https://doi.org/10.1038/bmt.2009.36

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