Long-Term Outcome of Autologous Hematopoietic Stem Cell Transplantation (AHSCT) for Acute Myeloid Leukemia (AML)- Single Center Retrospective Analysis

Abstract

For patients with acute myeloid leukemia (AML) in complete remission without an acceptable HLA donor, the autologous hematopoietic stem cell transplantation (AHSCT) may remain a therapeutic option as remission consolidation, however its role is still a subject of continued debate. One hundred and twenty patients who underwent AHSCT for AML were included in this retrospective single center analysis. The procedure was performed over a 19 years period and transplanted patients were in first complete remission (CR1; n = 109) or in second CR (CR2; n = 11). The median age at transplant was 37 years (range 18–64). The source of stem cells was bone marrow (n = 61; 50.8%), peripheral blood (n = 36; 30%) and bone marrow with peripheral blood (n = 23; 19.2%). The median time from AML diagnosis to AHSCT was 0.8 year (range 0.3–4.4) and the median follow-up after AHSCT for surviving patients was 12.8 years (range 3.1–20.5). The median LFS was 1.1 year. The probability of LFS calculated at 5 years and 10 years after transplantation was 28% (95%CI, 22%–32%) and 21% (95%CI, 18%–24%), respectively. The last relapse occurred 14.8 years after AHSCT and among patients who survived >2 years, 28.4% (27/95) had leukemia recurrence. The median OS was 1.7 years. The probability of OS after 5 years and 10 years was 29% and 22%, respectively. There was a tendency for increased LFS for patients younger than 50 years at transplant if compared to older population. AHSCT for AML was safe with acceptable toxicity profile. Leukemia recurrence remained the leading cause of death.

Safety and efficacy of a modified busulfan/cyclophosphamide conditioning regimen incorporating cladribine for autologous hematopoietic stem cell transplantation in acute myeloid leukemia

“…Nonhematological toxicity during conditioning was mainly gastrointestinal reactions, hepatic injury, and infection, all of which were without exceeding grade 3 and were alleviated after active treatment. In terms of hematologic toxicity, all patients had grade IV myelosuppression after conditioning to achieve the purpose of myeloid removal, and all patients obtained hematopoietic reconstitution after transplantation with a median time to neutrophil and platelet reconstitution of +13 d and +28 d respectively, which was consistent with literature reports (Simancikova et al, 2017;Helbig et al, 2018). No transplantation-related deaths were recorded.…”

Autologous Hematopoietic Stem Cell Transplantation in Acute Myelogenous Leukemia

“…Saraceni et al [2] found that age >50 years was an independent prognosis factor for poor survival outcomes in patients with AML who underwent ASCT. Nagler et al [22] reported that in patients with AML in CR1, OS (77 § 2% versus 56.3 § 3%; P < .001), LFS (61 § 3% versus 45 § 3%; P < .001), and NRM (4 § 1% versus 10 § 2%; P < .001) were superior in those age <50 years compared with older patients, consistent with results of other studies [23,24,26]. In another study, the cutoff age for distinguishing OS and LFS following ASCT was 55 years [28].…”

“…Mollee et al [50] found differing survival outcomes in patients who autografted in CR1 and those who autografted in CR2, with higher 8-year EFS and OS in patients who autografted in CR1. However, Helbig et al [26] recently reported no differences between patients who autografted in CR1 and those who did so in CR2. Similarly, Nagler et al [22] found no differences in survival outcomes between patients with AML autografted in CR1 or in CR2 on univariate and multivariate analyses.…”

“…The number of infused CD34 + cells can also affect clinical outcomes [61]. Several studies have shown no significant differences in OS, LFS, and RR in patients who undergo ASCT with peripheral blood or bone marrow as the stem cell source [2,23,26]. Low CD34 + cell counts (<2.0 £ 10 6 /kg) are not conducive to engraftment [62], and higher CD34 + cell counts (>7.16 £ 10 6 /kg) are related to higher RR [63], which may be caused by remnants of leukemia in the autograft.…”

Nouvelle approche thérapeutique complémentaire par des mobilisateurs naturels de cellules souches dans les processus de régénération et de réparation

“…Les cellules souches du cordon entraînent généralement moins de risque de GVHD vu que les cellules immunitaires transplantées sontp lus immatures mais le taux de récupération suite à la phase neutropénique est plus long et le nombre de cellules souches recueillis limité [37]. Les résultats des études comparant les différentes sources de CS en cas de leucémie aiguës, chroniques, ou de lymphomes non hodgkiniens sur le taux de survie à long terme rapportent des résultats hétérogènes selon l'utilisation de la chimiothérapie, la mobilisation ou non par le G-CSF au préalable, l'utilisation de thérapie d'immunosuppression, l'âge des patients, le stade de la maladie, la méthode de randomisation, le nombre de patients et le temps de suivi (entre 1e t1 5a ns) [35,[38][39][40][41]. Généralement, la greffe de cellules souches améliore le temps de survie et réduit le taux de mortalité comparéàl'absence de greffe en particulier en cas de leucémie aiguë mais il est difficile de conclure à ce stade qu'une source est plus efficace qu'une autre [42][43][44].…”