Article

[Comparison of autologous and allogeneic hematopoietic stem cell transplantation for 140 patients with de novo acute leukemia in first complete remission].

Institute of Hematology and Blood Diseases Hospital, CAMS and PUMC, Tianjin 300020, China.
Zhonghua xue ye xue za zhi = Zhonghua xueyexue zazhi 07/2004; 25(7):389-92.
Source: PubMed

ABSTRACT

To evaluate the outcome of patients with de novo acute leukemia (AL, no AML-M(3)) in CR(1) undergone autologous hematopoietic stem cell transplantation (auto-HSCT) or HLA-identical sibling allogeneic HSCT (allo-HSCT).
Forty-six AL patients received allo-HSCT and 94 received auto-HSCT in CR(1). The conditioning regimens mainly consisted of TBICy, BuCy and MAC. Cyclosporine plus methotrexate, or cyclosporine alone, or FK506 alone was used for graft-versus-host disease (GVHD) prophylaxis. Among auto-HSCT group, 39 patients received purged autologous bone marrow and 38 received immunotherapy and/or maintenance chemotherapy after transplant.
Myeloid reconstitution was achieved in all patients. After a median of 700 (range, 18 approximately 5563) days follow-up, the probabilities of leukemia-free survival (LFS) at 5 year were not significantly different in these two groups: (51.5 +/- 5.4)% for auto-HSCT group and (52.8 +/- 7.6)% for allo-HSCT group (P > 0.05). There was a lower cumulative relapse incidence (RI) [(26.3 +/- 6.9)% vs. (52.0 +/- 5.5)%, P > 0.05] but a significantly higher cumulative transplant-related mortality (TRM) [(37.6 +/- 7.8% vs. (14.4 +/- 4.1)%, P < 0.05] in the allo-HSCT group than in auto-HSCT group. Among auto-HSCT group, the patients received purged autografts and/or post-transplant therapy had significantly better LFS and lower RI (P < 0.05) than those received unpurged autografts or no post-transplant treatments [5-y LFS: (62.8 +/- 6.8)% and (38.4 +/- 8.4)%; RI: (37.7 +/- 6.8)% and (74.2 +/- 8.7)%, respectively].
The long-term LFS of auto-HSCT was comparable to that of allo-HSCT in the management of patients with AL in CR(1), because autograft purging and post-transplant treatment can significantly decrease relapse of auto-HSCT patients and auto-HSCT has lower therapy-related toxicities.

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    ABSTRACT: Background: Auto hemopoietic stem cell transplantation (Auto-HSCT) has a high relapse rate in acute leukemia; allo-HSCT has a high incidence of transplant-related mortality. It may increase curative effect when leukemia patients are administered adoptive immunotherapy post mixed-HSCT. Objective: To explore the curative effect of using donor lymphocyte infusion combined with interleukin-2 (DLI+IL-2) after autologous bone marrow mixed with H-2 haploidentical allogeneic bone marrow transplantation (MBMT) in mice with leukemia. Methods: Leukemia models were prepared with Balb/c mice which were irradiated 3 Gy by linear accelerator and injected K562 (GFP+/NeoR+) or K562 (GFP-/NeoR-) cells 5×105 into caudal vein and divided into leukemia model group, irradiated leukemia model group, MBMT group, and autologous bone marrow transplantation (ABMT) group. 6 Gy irradiation was performed after 7 days; the mice were treated with ABMT or MBMT respectively. Mice of MBMT group mixed with 1/10 of H-2 haploidentical allogeneic bone marrow cells underwent IL-2 or combination of DLI treatment. Peripheral blood and bone marrow cell morphous of mice were examined; cell subsets, GFP and NeoR gene in peripheral blood, and liver, spleen homogenate cells, and NeoR gene were detected after 4 weeks. Results and Conclusion: All of mice in leukemia model group died of bone marrow hematopoietic failure within 20 days; mice in irradiated leukemia model group died of hematopoietic failure within 14 days. Varying amounts of non-leukemic of mice survived for more than 28 days between ABMT group and MBMT group. UsingIL-2 treatment after MBMT and ABMT can promote long term disease free survival of mice with leukemia, and which combined with DLI can further improve long term disease free survival of mice with leukemia.
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