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Auto-SCT for AML in second remission: CALGB study 9620.

C A Linker¹, K Owzar, B Powell

¹Department of Medicine, University of California, San Francisco, CA 94143, USA. linkerc@medicine.ucsf.edu

Bone Marrow Transplantation

|March 18, 2009

Summary

This study explored a two-step autologous stem cell transplant (Auto-SCT) for acute myeloid leukemia (AML). The approach effectively mobilizes stem cells and shows promising results, particularly for acute promyelocytic leukemia (APL) patients.

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Area of Science:

Hematology
Oncology
Stem Cell Transplantation

Background:

Autologous stem cell transplantation (Auto-SCT) is a critical treatment for acute myeloid leukemia (AML).
Optimizing stem cell mobilization and preparative regimens is essential for improving Auto-SCT outcomes in AML patients.

Purpose of the Study:

To evaluate the feasibility and efficacy of a novel two-step Auto-SCT approach for AML patients in second remission.
To assess CD34+ stem cell mobilization and long-term outcomes, including disease-free survival (DFS).

Main Methods:

A two-step protocol involving consolidation chemotherapy (cytarabine and etoposide) followed by G-CSF stimulated peripheral blood stem cell (PBSC) collection.
Step 2 involved Auto-SCT with a preparative regimen of oral busulfan (BU) and intravenous etoposide.

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Fifty AML patients in second remission were enrolled; outcomes were analyzed with a median follow-up of 8.2 years.

Main Results:

Successful CD34+ stem cell mobilization was achieved, with a median collected dose of 5.9 x 10^6/kg.
The overall 5-year disease-free survival (DFS) was 28%.
Cytogenetics significantly impacted outcomes, with acute promyelocytic leukemia (APL) patients achieving a 5-year DFS of 67% compared to 16% for other AML subtypes.

Conclusions:

The described two-step Auto-SCT approach is feasible and effectively mobilizes CD34+ stem cells.
This strategy has led to cures in some AML patients, with particularly encouraging results for APL.
Further investigation into this protocol for specific AML subtypes is warranted.