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High-dose idarubicin plus busulfan as conditioning regimen to autologous stem cell transplantation: Promising post-remission therapy for acute myeloid leukemia in first complete remission?

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Abstract

The optimal post-remission therapy (PRT) for acute myeloid leukemia (AML) remains uncertain. We reported 32 AML patients in first complete remission (CR1) undergoing autologous hematopoietic stem cell transplantation (ASCT) with a characteristic conditioning regimen, termed I-Bu, based on high-dose idarubicin plus busulfan, which considerably strengthened antileukemic activity. Most patients were in better or intermediate-risk group except that cytogenetic or molecular risk information was missing for 18.7 % of the patients. Unpurged peripheral blood stem cells were used in all the cases. The adverse effects were mild and reversible. Only one case of transplant-related mortality was observed. All the patients in this study acquired hematopoietic reconstitution after ASCT. After a median follow-up of 30 (6–119) months, 24 patients (75.0 %) were alive in which 20 (62.5 %) patients were in continuous CR. There were 11 (34.4 %) patients who relapsed after HSCT. Cumulative relapse probability was about 40 % after 24 months. Median OS and DFS have not been reached. Patients in the better and intermediate-risk group had different clinical outcomes, but the differences were not statistically significant. ASCT with I-Bu regimen is possibly promising PRT for better and intermediate-risk AML patients in CR1.

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References

  1. O’donnell MR, Abboud CN, Altman J, et al. Acute myeloid leukemia. J Natl Compr Canc Netw. 2012;10:984–1021.

    PubMed  Google Scholar 

  2. Gupta V, Tallman MS, Weisdorf DJ. Allogeneic hematopoietic cell transplantation for adults with acute myeloid leukemia: myths, controversies, and unknowns. Blood. 2011;117:2307–18.

    Article  CAS  PubMed  Google Scholar 

  3. Keating A, Dasilva G, Perez WS, et al. Autologous blood cell transplantation versus HLA-identical sibling transplantation for acute myeloid leukemia in first complete remission: a registry study from the Center for International Blood and Marrow Transplantation Research. Haematologica. 2013;98:185–92.

    Article  PubMed Central  PubMed  Google Scholar 

  4. Burnett AK, Goldstone AH, Stevens RM, et al. Randomised comparison of addition of autologous bone-marrow transplantation to intensive chemotherapy for acute myeloid leukaemia in first remission: results of MRC AML 10 trial. UK Medical Research Council Adult and Children’s Leukaemia Working Parties. Lancet. 1998;351:700–8.

    Article  CAS  PubMed  Google Scholar 

  5. Mollee P, Gupta V, Song K, et al. Long-term outcome after intensive therapy with etoposide, melphalan, total body irradiation and autotransplant for acute myeloid leukemia. Bone Marrow Transplant. 2004;33:1201–8.

    Article  CAS  PubMed  Google Scholar 

  6. Suciu S, Mandelli F, De Witte T, et al. Allogeneic compared with autologous stem cell transplantation in the treatment of patients younger than 46 years with acute myeloid leukemia (AML) in first complete remission (CR1): an intention-to-treat analysis of the EORTC/GIMEMAAML-10 trial. Blood. 2003;102:1232–40.

    Article  CAS  PubMed  Google Scholar 

  7. Guieze R, Cornillet-Lefebvre P, Lioure B, et al. Role of autologous hematopoietic stem cell transplantation according to the NPM1/FLT3-ITD molecular status for cytogenetically normal AML patients: a GOELAMS study. Am J Hematol. 2012;87:1052–6.

    Article  PubMed  Google Scholar 

  8. Majhail NS, Bajorunaite R, Lazarus HM, et al. High probability of long-term survival in 2-year survivors of autologous hematopoietic cell transplantation for AML in first or second CR. Bone Marrow Transplant. 2011;46:385–92.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  9. Vellenga E, Van Putten W, Ossenkoppele GJ, et al. Autologous peripheral blood stem cell transplantation for acute myeloid leukemia. Blood. 2011;118:6037–42.

    Article  CAS  PubMed  Google Scholar 

  10. Wang J, Ouyang J, Zhou R, et al. Autologous hematopoietic stem cell transplantation for acute myeloid leukemia in first complete remission: a meta-analysis of randomized trials. Acta Haematol. 2010;124:61–71.

    Article  PubMed  Google Scholar 

  11. Breems DA, Boogaerts MA, Dekker AW, et al. Autologous bone marrow transplantation as consolidation therapy in the treatment of adult patients under 60 years with acute myeloid leukaemia in first complete remission: a prospective randomized Dutch-Belgian Haemato-Oncology Co-operative Group (HOVON) and Swiss Group for Clinical Cancer Research (SAKK) trial. Br J Haematol. 2005;128:59–65.

    Article  PubMed  Google Scholar 

  12. Gorin NC, Labopin M, Frassoni F, et al. Identical outcome after autologous or allogeneic genoidentical hematopoietic stem-cell transplantation in first remission of acute myelocytic leukemia carrying inversion 16 or t(8;21): a retrospective study from the European Cooperative Group for Blood and Marrow Transplantation. J Clin Oncol. 2008;26:3183–8.

    Article  PubMed  Google Scholar 

  13. Linker CA. Autologous stem cell transplantation for acute myeloid leukemia. Bone Marrow Transplant. 2003;31:731–8.

    Article  CAS  PubMed  Google Scholar 

  14. Linker CA, Ries CA, Damon LE, et al. Autologous stem cell transplantation for acute myeloid leukemia in first remission. Biol Blood Marrow Transplant. 2000;6:50–7.

    Article  CAS  PubMed  Google Scholar 

  15. Buccisano F, Maurillo L, Spagnoli A, et al. Cytogenetic and molecular diagnostic characterization combined to postconsolidation minimal residual disease assessment by flow cytometry improves risk stratification in adult acute myeloid leukemia. Blood. 2010;116:2295–303.

    Article  CAS  PubMed  Google Scholar 

  16. Ferrara F, Annunziata M, Schiavone EM, et al. High-dose idarubicin and busulphan as conditioning for autologous stem cell transplantation in acute myeloid leukemia: a feasibility study. Hematol J. 2001;2:214–9.

    Article  CAS  PubMed  Google Scholar 

  17. Ferrara F, Izzo T, Criscuolo C, et al. Favorable outcome in patients with acute myelogenous leukemia with the nucleophosmin gene mutation autografted after conditioning with high-dose continuous infusion of idarubicin and busulfan. Biol Blood Marrow Transplant. 2010;16:1018–24.

    Article  CAS  PubMed  Google Scholar 

  18. Ferrara F, Palmieri S, Annunziata M, et al. Continuous infusion idarubicin and oral busulfan as conditioning for patients with acute myeloid leukemia aged over 60 years undergoing autologous stem cell transplantation. Bone Marrow Transplant. 2004;34:573–6.

    Article  CAS  PubMed  Google Scholar 

  19. Ferrara F, Palmieri S, Pedata M, et al. Autologous stem cell transplantation for elderly patients with acute myeloid leukaemia conditioned with continuous infusion idarubicin and busulphan. Hematol Oncol. 2009;27:40–5.

    Article  CAS  PubMed  Google Scholar 

  20. Yin CC, Medeiros LJ, Bueso-Ramos CE. Recent advances in the diagnosis and classification of myeloid neoplasms–comments on the 2008 WHO classification. Int J Lab Hematol. 2010;32:461–76.

    Article  CAS  PubMed  Google Scholar 

  21. Berman E, Heller G, Santorsa J, et al. Results of a randomized trial comparing idarubicin and cytosine arabinoside with daunorubicin and cytosine arabinoside in adult patients with newly diagnosed acute myelogenous leukemia. Blood. 1991;77:1666–74.

    CAS  PubMed  Google Scholar 

  22. Qian SX, Li JY, Tian T, et al. Effect of low-dose cytarabine and aclarubicin in combination with granulocyte colony-stimulating factor priming (CAG regimen) on the outcome of elderly patients with acute myeloid leukemia. Leuk Res. 2007;31:1383–8.

    Article  CAS  PubMed  Google Scholar 

  23. Burnett A, Wetzler M, Lowenberg B. Therapeutic advances in acute myeloid leukemia. J Clin Oncol. 2011;29:487–94.

    Article  PubMed  Google Scholar 

  24. Buchner T, Berdel WE, Schoch C, et al. Double induction containing either two courses or one course of high-dose cytarabine plus mitoxantrone and postremission therapy by either autologous stem-cell transplantation or by prolonged maintenance for acute myeloid leukemia. J Clin Oncol. 2006;24:2480–9.

    Article  PubMed  Google Scholar 

  25. Jung AS, Holman PR, Castro JE, et al. Autologous hematopoietic stem cell transplantation as an intensive consolidation therapy for adult patients in remission from acute myelogenous leukemia. Biol Blood Marrow Transplant. 2009;15:1306–13.

    Article  CAS  PubMed  Google Scholar 

  26. Singh H, Werner LL, Asali S, et al. Comparison of autologous stem cell transplantation versus consolidation chemotherapy for patients with cytogenetically normal acute myeloid leukemia (CN-AML) and FLT3ITD. Am J Hematol. 2011;86:625–7.

    Article  PubMed Central  PubMed  Google Scholar 

  27. Tallman MS, Perez WS, Lazarus HM, et al. Pretransplantation consolidation chemotherapy decreases leukemia relapse after autologous blood and bone marrow transplants for acute myelogenous leukemia in first remission. Biol Blood Marrow Transplant. 2006;12:204–16.

    Article  CAS  PubMed  Google Scholar 

  28. Zittoun RA, Mandelli F, Willemze R, et al. Autologous or allogeneic bone marrow transplantation compared with intensive chemotherapy in acute myelogenous leukemia. European Organization for Research and Treatment of Cancer (EORTC) and the Gruppo Italiano Malattie Ematologiche Maligne dell’Adulto (GIMEMA) Leukemia Cooperative Groups. N Engl J Med. 1995;332:217–23.

    Article  CAS  PubMed  Google Scholar 

  29. Dohner H, Estey EH, Amadori S, et al. Diagnosis and management of acute myeloid leukemia in adults: recommendations from an international expert panel, on behalf of the European LeukemiaNet. Blood. 2010;115:453–74.

    Article  PubMed  Google Scholar 

  30. Koreth J, Schlenk R, Kopecky KJ, et al. Allogeneic stem cell transplantation for acute myeloid leukemia in first complete remission: systematic review and meta-analysis of prospective clinical trials. JAMA. 2009;301:2349–61.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  31. Pfirrmann M, Ehninger G, Thiede C, et al. Prediction of post-remission survival in acute myeloid leukaemia: a post hoc analysis of the AML96 trial. Lancet Oncol. 2012;13:207–14.

    Article  PubMed  Google Scholar 

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Acknowledgments

This study was supported by the National Natural Science Foundation of China (81200362, 81070456 and 81270652), the Program for Development of Innovative Research Team in the First Affiliated Hospital of NJMU, the Project Funded by the Priority Academic Program Development of Jiangsu Higher Education Institutions and the Project of the National Key Clinical Specialty.

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The authors have declared no conflict of interest.

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Authors and Affiliations

  1. Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China

    Ming Hong, Kou-Rong Miao, Run Zhang, Hua Lu, Peng Liu, Wei Xu, Li-Juan Chen, Su-Jiang Zhang, Han-Xin Wu, Hong-Xia Qiu, Jian-Yong Li & Si-Xuan Qian

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  1. Ming Hong
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  2. Kou-Rong Miao
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  3. Run Zhang
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  4. Hua Lu
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Correspondence to Jian-Yong Li or Si-Xuan Qian.

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Hong, M., Miao, KR., Zhang, R. et al. High-dose idarubicin plus busulfan as conditioning regimen to autologous stem cell transplantation: Promising post-remission therapy for acute myeloid leukemia in first complete remission?. Med Oncol 31, 980 (2014). https://doi.org/10.1007/s12032-014-0980-x

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