Autologous peripheral blood stem cell transplantation in first remission adult acute myeloid leukaemia--an intention to treat analysis and comparison of outcome using a predictive model based on the MRC AML10 cohort

Hematology. 2003 Apr;8(2):83-90. doi: 10.1080/1024533031000090793.

Abstract

The role of autologous peripheral blood stem cell transplantation (APBSCT) in acute myeloid leukaemia (AML) remains controversial. The current study evaluated the application of APBSCT in a large consecutive series of patients with untreated AML, and compared outcome with a predictive model based on MRC AML10 data. Of 148 evaluable patients, 118 patients entered complete remission (CR) after induction therapy comprising three cycles of daunorubicin, cytosine arabinoside and oral 6-thioguanine. Of these patients, 68 (57%) proceeded to consolidation therapy with two courses of intermediate dose cytosine arabinoside, and stem cell mobilisation, and 40 of these patients (34%) underwent the APBSCT procedure after high dose busulphan conditioning. Harvest quality was the main factor precluding APBSCT. Five-year event-free survival (EFS) in patients who achieved CR was 38% and in APBSCT patients was 57%. There were no transplant-related deaths. No significant differences were demonstrated between observed and expected outcomes at 1 and 2 years, based on the predictive model derived from the MRC AML10 study. These data therefore indicate that only a third of eligible adult patients will undergo APBSCT. However, the results demonstrate favourable survival in such patients, with no transplant-related mortality.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease
  • Adolescent
  • Adult
  • Aged
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Busulfan
  • Clinical Trials as Topic
  • Cohort Studies
  • Combined Modality Therapy
  • Cytarabine / administration & dosage
  • Daunorubicin / administration & dosage
  • Disease-Free Survival
  • Female
  • Granulocyte Colony-Stimulating Factor
  • Hematopoietic Stem Cell Mobilization
  • Humans
  • Leukemia, Myeloid / drug therapy
  • Leukemia, Myeloid / mortality
  • Leukemia, Myeloid / therapy*
  • Life Tables
  • Male
  • Middle Aged
  • Models, Biological
  • Peripheral Blood Stem Cell Transplantation*
  • Remission Induction
  • Risk
  • Survival Analysis
  • Thioguanine / administration & dosage
  • Transplantation Conditioning
  • Transplantation, Autologous
  • Treatment Outcome

Substances

  • Cytarabine
  • Granulocyte Colony-Stimulating Factor
  • Thioguanine
  • Busulfan
  • Daunorubicin