High numbers of mobilized CD34+ cells collected in AML in first remission are associated with high relapse risk irrespective of treatment with autologous peripheral blood SCT or autologous BMT

• Published in: Bone marrow transplantation (Basingstoke) Vol. 50; no. 3; pp. 341 - 347
• Main Authors: Hengeveld, M, Suciu, S, Chelgoum, Y, Marie, J-P, Muus, P, Lefrère, F, Mandelli, F, Pane, F, Amadori, S, Fioritoni, G, Labar, B, Baron, F, Cermak, J, Bourhis, J-H, Storti, G, Fazi, P, Hagemeijer, A, Vignetti, M, Willemze, R, de Witte, T
• Format: Journal Article Web Resource
• Language: English
• Published: London Nature Publishing Group UK 01-03-2015; Nature Publishing Group
• Subjects: 13; 13/100; 692/308/2171; 692/308/575; Acute myelocytic leukemia; Acute myeloid leukemia; Adolescent; Adult; Antibiotics; Antigens, CD34 - metabolism; Blood; Bone marrow; Bone marrow transplantation; Bone Marrow Transplantation - methods; Care and treatment; CD34 antigen; Cell Biology; Confidence intervals; Disease-Free Survival; Female; Genetic aspects; Health aspects; Hematology; Hematopoietic Stem Cell Mobilization - methods; Hematopoietic Stem Cell Transplantation - methods; Histocompatibility antigen HLA; Human health sciences; Humans; Hématologie; Internal Medicine; Intravenous administration; Leukemia; Leukemia, Myeloid, Acute - blood; Leukemia, Myeloid, Acute - therapy; Leukocytes (neutrophilic); Male; Medicine; Medicine & Public Health; Middle Aged; original-article; Patient outcomes; Patients; Peripheral blood; Platelets; Public Health; Randomization; Recovery; Recurrence; Remission; Remission Induction; Risk; Risk Factors; Sciences de la santé humaine; Stem cell transplantation; Stem Cells; Transfusion; Transplantation Conditioning - methods; Transplantation, Autologous; Young Adult; France; Netherlands
• ISSN: 0268-3369; 1476-5365; 1476-5365
• DOI: 10.1038/bmt.2014.262

The faster hematopoietic recovery after autologous peripheral blood SCT (APBSCT) in patients with AML may be offset by an increased relapse risk as compared with autologous BMT (ABMT). The EORTC and GIMEMA Leukemia Groups conducted a trial (AML-10) in which they compared, as second randomization, APBSCT and ABMT in first CR patients without an HLA compatible donor. A total of 292 patients were randomized. The 5-year DFS rate was 41% in the APBSCT arm and 46% in the ABMT arm with a hazard ratio (HR) of 1.17; 95% confidence interval=0.85–1.59;
P
=0.34. The 5-year cumulative relapse incidence was 56% vs 49% (
P
=0.26), and the 5-year OS 50% and 55% (
P
=0.6) in the APBSCT and ABMT groups, respectively. APBSCT was associated with significantly faster recovery of neutrophils and platelets, shorter duration of hospitalization, reduced need of transfusion packed RBC and less days of intravenous antibiotics. In both treatment groups, higher numbers of mobilized CD34+ cells were associated with a significantly higher relapse risk irrespective of the treatment given after the mobilization. Randomization between APBSCT and ABMT did not result in significantly different outcomes in terms of DFS, OS and relapse incidence.