Autologous Hematopoietic Stem Cell Transplantation for Adults With Acute Myeloid Leukemia

Hematopoietic stem cell transplantation (HSCT) remains the most efficacious therapy in patients with acute leukemia. For older patients and those lacking a related HLA-compatible donor, autologous transplantation (auto-HSCT) is a valid alternative therapeutic option.

From 1997 until 2014 in the Department of Hematooncology and Bone Marrow Transplantation, Medical University of Lublin, Poland, 29 auto-HSCT were performed in patients with acute myeloid leukemia (AML; 15 men and 14 women; median age, 52.2 years). The following FAB types of AML were diagnosed: M0, 3; M1, 4; M2, 6; M4, 10; and M5, 6. Patients with AML were classified into 3 cytogenetic prognostic groups: high risk, 9; intermediate risk, 16; and low risk, 4. Twenty-five were in first complete remission and 4 in second complete remission. The peripheral HSCs mobilized after chemotherapy (mainly second course of consolidation) and granulocyte colony-stimulating factor were the source of the stem cells in all cases. The median number of infused CD34+ cells was 3.58 × 10(6)/kg. The conditioning regimen was busulfan and cyclophosphamide in all patients with AML. The intravenous form of busulfan was applied in the last 15 patients.

The median time for absolute neutrophil count recovery >0.5 × 10(9)/L and for platelet count >20.0 × 10(9)/L was 12 and 16.5 days, respectively. Treatment-related mortality rate in the whole group was 3.4% (1 patient with sepsis in the aplastic period). The median follow-up time of survivors was 21.9 months (range, 11.7-142.4). The 3-year projected disease-free survival and overall survival rates were 60% and 68%, respectively.

Our data confirm that auto-HSCT is a valuable therapeutic option for patients with AML, especially older patients and those lacking related HLA-compatible donors.