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Treatment of acute mixed-cell leukemia with autologous hematopoietic SCT followed by allogeneic hematopoietic stem cell micro-transplantation

Bone Marrow Transplantation volume 49, pages 984–985 (2014)Cite this article

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Acute mixed-cell leukemia (AMAL) is defined as acute leukemia that possesses characteristics of both lymphoid and myeloid precursor cells.1 The prognosis of AMAL is poor, with an average OS of only 10 months in patients treated by chemotherapy alone, which is far shorter than that for patients with acute leukemias with single lineage origins.2 Although allogeneic hematopoietic SCT (allo-HSCT) can significantly prolong patient survival,3 intensified preconditioning is required to ensure long-term survival,4 which usually is not possible in elderly patients. However, in contrast to traditional allo-HSCT, related allogeneic hematopoietic stem cell micro-transplantation has been shown to be feasible and effective in elderly patients with AML.5

We treated a 59-year-old man with AMAL with auto-HSCT followed by allogeneic hematopoietic stem cell micro-transplantation. He was admitted in November 2011 with 1-month history of a neck mass. Routine blood tests on admission showed a WBC count of 2.4 × 109/L, hemoglobin 8.5 g/dL and platelets 146 × 109/L. A BM aspirate revealed 32.5% blast cells. The immunophenotyping results showed that blast cells were positive for HLA-DR, CD15, mCD19, CD22, CD33, CD117, MPO and cCD22. Fusion gene screening proved positive for AML/ETO. The patient was diagnosed with AMAL, and chemotherapy with vincristine, daunorubicin, Ara-C and prednisone (VDAP regimen) was initiated in December 2011. The patient achieved CR after chemotherapy. He subsequently received two cycles of chemotherapy as consolidation, including one cycle of Ara-C plus PEG-asparaginase and one cycle of fludarabine, Ara-C and G-CSF (FLAG). Because of his advanced age, he and his relatives opted for auto-HSCT rather than allo-HSCT. In May 2012, the patient received mobilization with mitoxantrone, vincristine, Ara-c, dexamethasone and MTX. PMNCs (9.12 × 109/kg) and CD34+ (5.48 × 106/kg) were collected. After conditioning with BU (4 mg/kg/day, d1−4), etoposide (800 mg/m2/day, d1−2), Ara-c (3.0 g/m2 q12h, d1−2) and dexamethasone (15 mg/day, d1−4), autologous PMNCs were reinfused in June 2012. Hematopoiesis was reconstituted 33 days post transplantation. A clinical examination performed 41 days post transplantation demonstrated continuing CR, but a BM biopsy showed small clusters of immature precursor cells. He was also positive for the Wilm’s tumor-1 (WT1) gene, which is an indicator for early leukemia relapse,6 with a WT1/ABL copy number beyond the normal range (218/1 × 104; range: <140/1 × 104).

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  1. Department of Hematology, 303rd Hospital of the Peoplès Liberation Army, Nanning, China

    Y-S Chen, X-J Kong, X-H Zhang & X-L Yin

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  1. Y-S Chen
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Correspondence to X-L Yin.

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Chen, YS., Kong, XJ., Zhang, XH. et al. Treatment of acute mixed-cell leukemia with autologous hematopoietic SCT followed by allogeneic hematopoietic stem cell micro-transplantation. Bone Marrow Transplant 49, 984–985 (2014). https://doi.org/10.1038/bmt.2014.74

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