Long-Term Follow-up of Allogeneic Hematopoietic Stem Cell Transplantation for De Novo Acute Myelogenous Leukemia with a Conditioning Regimen of Total Body Irradiation and Granulocyte Colony-Stimulating Factor-Combined High-Dose Cytarabine

Takehiko Mori, Yoshinobu Aisa, Reiko Watanabe, Rie Yamazaki, Jun Kato, Takayuki Shimizu, Naoyuki Shigematsu, Atsushi Kubo, Tomonaru Yajima, Toshifumi Hibi, Yasuo Ikeda, Shinichiro Okamoto

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Abstract

We retrospectively evaluated the efficacy and safety of total body irradiation (TBI) and granulocyte colony-stimulating factor (G-CSF)-combined high-dose cytarabine as a conditioning regimen for allogeneic hematopoietic stem cell transplantation (HSCT) in patients with de novo acute myelogenous leukemia (AML). The conditioning regimen consisted of 12 Gy of TBI followed by high-dose cytarabine (3 g/m2) every 12 hours for 4 days in combination with the continuous administration of G-CSF. Stem cell sources included bone marrow or peripheral blood stem cells (PBSC) from human leukocyte antigen (HLA)-identical siblings (n = 24), or bone marrow from HLA serologically matched unrelated donors (n = 26). Fifty patients (median age, 38 years) were evaluated. At HSCT, 35 patients were in the first or second complete remission (CR1/2), and 15 patients were not in remission (n = 14) or in the third CR (n = 1). Thirty-six of 50 patients are currently alive, with a median follow-up period of 5.6 years (range: 1.1-12.1 years). The 5-year estimated overall survival (OS) and disease-free survival (DFS) rates were 85.5% (95% confidence interval [CI], 73.7%-97.3%) and 82.1% (95% CI, 69.0%-95.2%) in patients with AML in the first or second CR, 46.7% (95% CI, 21.4%-72.0%), and 40.0% (95% CI, 15.3%-64.7%) in patients with AML in other stages. The 2-year cumulative incidence of treatment-related mortality (TRM) of all patients was 10.4% (95% CI, 1.8%-18.6%). The only factors affecting the OS and DFS were disease status at transplant and cytogenetics by multivariate analysis. These results suggest that G-CSF-combined high-dose cytarabine could be a promising component of the conditioning regimen for allogeneic HSCT for AML, providing a high DFS and low TRM.

Original languageEnglish
Pages (from-to)651-657
Number of pages7
JournalBiology of Blood and Marrow Transplantation
Volume14
Issue number6
DOIs
Publication statusPublished - 2008 Jun

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Whole-Body Irradiation
Hematopoietic Stem Cell Transplantation
Cytarabine
Granulocyte Colony-Stimulating Factor
Acute Myeloid Leukemia
Confidence Intervals
Disease-Free Survival
HLA Antigens
Bone Marrow
Unrelated Donors
Survival
Mortality
Conditioning (Psychology)
Cytogenetic Analysis
Siblings
Stem Cells
Multivariate Analysis
Survival Rate
Transplants
Safety

Keywords

  • Acute myelogenous leukemia
  • Allogeneic hematopoietic stem cell transplantation
  • Granulocyte colony-stimulating factor
  • High-dose cytarabine

ASJC Scopus subject areas

  • Transplantation

Cite this

@article{8862ceabe58b42cca4b9e0cbd7e790de,
title = "Long-Term Follow-up of Allogeneic Hematopoietic Stem Cell Transplantation for De Novo Acute Myelogenous Leukemia with a Conditioning Regimen of Total Body Irradiation and Granulocyte Colony-Stimulating Factor-Combined High-Dose Cytarabine",
abstract = "We retrospectively evaluated the efficacy and safety of total body irradiation (TBI) and granulocyte colony-stimulating factor (G-CSF)-combined high-dose cytarabine as a conditioning regimen for allogeneic hematopoietic stem cell transplantation (HSCT) in patients with de novo acute myelogenous leukemia (AML). The conditioning regimen consisted of 12 Gy of TBI followed by high-dose cytarabine (3 g/m2) every 12 hours for 4 days in combination with the continuous administration of G-CSF. Stem cell sources included bone marrow or peripheral blood stem cells (PBSC) from human leukocyte antigen (HLA)-identical siblings (n = 24), or bone marrow from HLA serologically matched unrelated donors (n = 26). Fifty patients (median age, 38 years) were evaluated. At HSCT, 35 patients were in the first or second complete remission (CR1/2), and 15 patients were not in remission (n = 14) or in the third CR (n = 1). Thirty-six of 50 patients are currently alive, with a median follow-up period of 5.6 years (range: 1.1-12.1 years). The 5-year estimated overall survival (OS) and disease-free survival (DFS) rates were 85.5{\%} (95{\%} confidence interval [CI], 73.7{\%}-97.3{\%}) and 82.1{\%} (95{\%} CI, 69.0{\%}-95.2{\%}) in patients with AML in the first or second CR, 46.7{\%} (95{\%} CI, 21.4{\%}-72.0{\%}), and 40.0{\%} (95{\%} CI, 15.3{\%}-64.7{\%}) in patients with AML in other stages. The 2-year cumulative incidence of treatment-related mortality (TRM) of all patients was 10.4{\%} (95{\%} CI, 1.8{\%}-18.6{\%}). The only factors affecting the OS and DFS were disease status at transplant and cytogenetics by multivariate analysis. These results suggest that G-CSF-combined high-dose cytarabine could be a promising component of the conditioning regimen for allogeneic HSCT for AML, providing a high DFS and low TRM.",
keywords = "Acute myelogenous leukemia, Allogeneic hematopoietic stem cell transplantation, Granulocyte colony-stimulating factor, High-dose cytarabine",
author = "Takehiko Mori and Yoshinobu Aisa and Reiko Watanabe and Rie Yamazaki and Jun Kato and Takayuki Shimizu and Naoyuki Shigematsu and Atsushi Kubo and Tomonaru Yajima and Toshifumi Hibi and Yasuo Ikeda and Shinichiro Okamoto",
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doi = "10.1016/j.bbmt.2008.03.006",
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pages = "651--657",
journal = "Biology of Blood and Marrow Transplantation",
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T1 - Long-Term Follow-up of Allogeneic Hematopoietic Stem Cell Transplantation for De Novo Acute Myelogenous Leukemia with a Conditioning Regimen of Total Body Irradiation and Granulocyte Colony-Stimulating Factor-Combined High-Dose Cytarabine

AU - Mori, Takehiko

AU - Aisa, Yoshinobu

AU - Watanabe, Reiko

AU - Yamazaki, Rie

AU - Kato, Jun

AU - Shimizu, Takayuki

AU - Shigematsu, Naoyuki

AU - Kubo, Atsushi

AU - Yajima, Tomonaru

AU - Hibi, Toshifumi

AU - Ikeda, Yasuo

AU - Okamoto, Shinichiro

PY - 2008/6

Y1 - 2008/6

N2 - We retrospectively evaluated the efficacy and safety of total body irradiation (TBI) and granulocyte colony-stimulating factor (G-CSF)-combined high-dose cytarabine as a conditioning regimen for allogeneic hematopoietic stem cell transplantation (HSCT) in patients with de novo acute myelogenous leukemia (AML). The conditioning regimen consisted of 12 Gy of TBI followed by high-dose cytarabine (3 g/m2) every 12 hours for 4 days in combination with the continuous administration of G-CSF. Stem cell sources included bone marrow or peripheral blood stem cells (PBSC) from human leukocyte antigen (HLA)-identical siblings (n = 24), or bone marrow from HLA serologically matched unrelated donors (n = 26). Fifty patients (median age, 38 years) were evaluated. At HSCT, 35 patients were in the first or second complete remission (CR1/2), and 15 patients were not in remission (n = 14) or in the third CR (n = 1). Thirty-six of 50 patients are currently alive, with a median follow-up period of 5.6 years (range: 1.1-12.1 years). The 5-year estimated overall survival (OS) and disease-free survival (DFS) rates were 85.5% (95% confidence interval [CI], 73.7%-97.3%) and 82.1% (95% CI, 69.0%-95.2%) in patients with AML in the first or second CR, 46.7% (95% CI, 21.4%-72.0%), and 40.0% (95% CI, 15.3%-64.7%) in patients with AML in other stages. The 2-year cumulative incidence of treatment-related mortality (TRM) of all patients was 10.4% (95% CI, 1.8%-18.6%). The only factors affecting the OS and DFS were disease status at transplant and cytogenetics by multivariate analysis. These results suggest that G-CSF-combined high-dose cytarabine could be a promising component of the conditioning regimen for allogeneic HSCT for AML, providing a high DFS and low TRM.

AB - We retrospectively evaluated the efficacy and safety of total body irradiation (TBI) and granulocyte colony-stimulating factor (G-CSF)-combined high-dose cytarabine as a conditioning regimen for allogeneic hematopoietic stem cell transplantation (HSCT) in patients with de novo acute myelogenous leukemia (AML). The conditioning regimen consisted of 12 Gy of TBI followed by high-dose cytarabine (3 g/m2) every 12 hours for 4 days in combination with the continuous administration of G-CSF. Stem cell sources included bone marrow or peripheral blood stem cells (PBSC) from human leukocyte antigen (HLA)-identical siblings (n = 24), or bone marrow from HLA serologically matched unrelated donors (n = 26). Fifty patients (median age, 38 years) were evaluated. At HSCT, 35 patients were in the first or second complete remission (CR1/2), and 15 patients were not in remission (n = 14) or in the third CR (n = 1). Thirty-six of 50 patients are currently alive, with a median follow-up period of 5.6 years (range: 1.1-12.1 years). The 5-year estimated overall survival (OS) and disease-free survival (DFS) rates were 85.5% (95% confidence interval [CI], 73.7%-97.3%) and 82.1% (95% CI, 69.0%-95.2%) in patients with AML in the first or second CR, 46.7% (95% CI, 21.4%-72.0%), and 40.0% (95% CI, 15.3%-64.7%) in patients with AML in other stages. The 2-year cumulative incidence of treatment-related mortality (TRM) of all patients was 10.4% (95% CI, 1.8%-18.6%). The only factors affecting the OS and DFS were disease status at transplant and cytogenetics by multivariate analysis. These results suggest that G-CSF-combined high-dose cytarabine could be a promising component of the conditioning regimen for allogeneic HSCT for AML, providing a high DFS and low TRM.

KW - Acute myelogenous leukemia

KW - Allogeneic hematopoietic stem cell transplantation

KW - Granulocyte colony-stimulating factor

KW - High-dose cytarabine

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U2 - 10.1016/j.bbmt.2008.03.006

DO - 10.1016/j.bbmt.2008.03.006

M3 - Article

VL - 14

SP - 651

EP - 657

JO - Biology of Blood and Marrow Transplantation

JF - Biology of Blood and Marrow Transplantation

SN - 1083-8791

IS - 6

ER -