Is there a role for autologous stem cell transplantation for patients with acute myelogenous leukaemia? A retrospective analysis.
Posted by rob on September 28, 2010 under Uncategorized | 
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Is there a role for autologous stem cell transplantation for patients with acute myelogenous leukaemia? A retrospective analysis.
Biol Blood Marrow Transplant. 2010 Sep 23;
Authors: Novitzky N, Thomas V, du Toit C, McDonald A
INTRODUCTION: For patients with AML who are unable to secure an acceptable HLA donor, the role of autologous stem cell transplantation has remained controversial. Its effectiveness remains unclear as, when analysed on intention to treat strategies, a significant number do not undergo the procedure, while others seem to fail therapy from pre transplant recurrences. METHODS: To improve our counselling to our patients on these two therapeutic options, we compared the outcome of patients in first remission of AML who actually underwent autologous or allogeneic transplantation. The choice for the type of graft was based on availability of HLA identical siblings. Patients received myeloablative conditioning followed by allogeneic or autologous cytokine mobilised peripheral blood stem cell transplantation. For prophylaxis of graft vs. host disease, grafts were incubated ex vivo with anti CD52 antibodies and patients were prescribed cyclosporin until day 90. Patients were stratified by clinical and laboratory factors as well as cytogenetic risk. The end points were TRM, DFS and OS. RESULTS: The median presentation age for both transplant groups was 35 (14-60) years. Of the 112 consecutive patients achieving remission, autologous or allogeneic grafts were transplanted to 43 and 32 patients respectively. There was no significant difference in the presentation clinical features, laboratory parameters, marrow morphology or proportion of low and intermediate cytogenetic risk for both transplant options. Treatment mortality as well as relapse rate was similar (14 and 15%; 39 and 27%, respectively). At a median of 1609 and 1819 post transplant days 56% and 63% in each group survive. In univariate analysis performance status, cytogenetic risk, morphological features of dysplasia, blast count and LDH were significant factors for survival. While for the entire group there was no difference in survival between both modalities, all patients with unfavourable cytogenetics receiving an autologous graft died of disease recurrence (3 year survival 35% vs 0%; p= 0.05). CONCLUSIONS: We conclude that patients with AML who have low or intermediate cytogenetic risk undergoing myeloablative conditioning followed by autologous or allogeneic T-cell depleted stem cell transplantation appeared to have similar outcome. However, those with unfavourable karyotype are unlikely to be cured with autologous grafts and are candidates for experimental modalities.
PMID: 20870030 [PubMed - as supplied by publisher]