Contributions
Abstract: EP1257
Type: E-Poster Presentation
Session title: Stem cell transplantation - Clinical
Background
How to reduce the recurrence of autologous hematopoietic stem cell transplantation in patients with acute myeloid leukemia is very important to improve the efficacy of transplantation.
Aims
To investigate the safety and efficacy of a modified busulfan(Bu)/cyclophosphamide(Cy) conditioning regimen incorporating cladribine(CLAD) for autologous hematopoietic stem cell transplantation(auto-HSCT) in acute myeloid leukemia(AML).
Methods
We retrospectively evaluated the clinical outcomes of patients with AML who had received auto-HSCT with conditioning incorporating CLAD at the Institute of Hematology and Blood Disease Hospital.
Results
Between September 2016 and February 2021, 20 adult patients with AML were enrolled including 13 males and 7 females with a median age of 32(range, 15 to 54) years. The median courses of chemotherapy before auto-HSCT were 4 courses(range, 3 to 9) and all patients were minimal residual disease(MRD) negative before auto-HSCT. Twelve out of the 20 AML patients received myeloablative conditioning regimens including:Bu 3.2 mg/kg/d*3, Cy 40mg/kg/d*2, CLAD 5mg/m2/d*3, cytarabine(Ara-c) 2g/m2/d*3 or idarubicin 12mg/m2/d*3. The other 8 patients with AML received the similar modified conditioning regimens as above mentioned but CLAD and Ara-c were administered for 5 days while Cy was abandoned for its adverse cardiovascular reactions. All the 20 patients received peripheral blood stem cells for auto-HSCT. The median amount of infused mononuclear cell and CD34+ stem cell were 9.05×108/kg(range, 2.88 to 20.97) and 1.99×106/kg(range, 1.59 to 10.44), respectively. All the 20 patients achieved neutrophil and platelet engraftment with a median time of 13(range, 10 to 34) days and 27(range, 14 to 113) days, respectively. Three patients suffered from septicemia during neutropenia stage, 2 patients suffered from pulmonary infection, the others suffered from mild to moderate infection or gastrointestinal reaction after conditioning and all were relieved by anti-infection and other supportive treatment. None of the patients died of transplant related complications. From 2 months after auto-HSCT, the maintenance therapy with interleukin-2, interferon or azacitidine was performed for 7 patients with FLT3- ITD mutation negative, sorafeni were performed for 2 patient with FLT3 -ITD mutation positive. At a median follow-up of 25.5(range, 2.5 to 52.5) months,four patients relapsed after auto-HSCT at a median time of 8(range, 0.5 to 18.5) months. One patients died due to leukemia relapse at 18 months after auto-HSCT, the other 19 patients were all alive including 16 patients with MRD negative and the other 3 patients achieved MRD negative after allogeneic HSCT or maintenance therapy. The estimated 2-year survival, relapse, and disease-free survival rates were 93.3%, 22.9% and 77.1%, respectively.
Conclusion
The modified conditioning incorporating CLAD was safe and effective for auto-HSCT in acute myeloid leukemia which might be confirmed by more clinical studies.
Keyword(s): Acute myeloid leukemia, Autologous hematopoietic stem cell transplantation, Cladribine, Conditioning
Abstract: EP1257
Type: E-Poster Presentation
Session title: Stem cell transplantation - Clinical
Background
How to reduce the recurrence of autologous hematopoietic stem cell transplantation in patients with acute myeloid leukemia is very important to improve the efficacy of transplantation.
Aims
To investigate the safety and efficacy of a modified busulfan(Bu)/cyclophosphamide(Cy) conditioning regimen incorporating cladribine(CLAD) for autologous hematopoietic stem cell transplantation(auto-HSCT) in acute myeloid leukemia(AML).
Methods
We retrospectively evaluated the clinical outcomes of patients with AML who had received auto-HSCT with conditioning incorporating CLAD at the Institute of Hematology and Blood Disease Hospital.
Results
Between September 2016 and February 2021, 20 adult patients with AML were enrolled including 13 males and 7 females with a median age of 32(range, 15 to 54) years. The median courses of chemotherapy before auto-HSCT were 4 courses(range, 3 to 9) and all patients were minimal residual disease(MRD) negative before auto-HSCT. Twelve out of the 20 AML patients received myeloablative conditioning regimens including:Bu 3.2 mg/kg/d*3, Cy 40mg/kg/d*2, CLAD 5mg/m2/d*3, cytarabine(Ara-c) 2g/m2/d*3 or idarubicin 12mg/m2/d*3. The other 8 patients with AML received the similar modified conditioning regimens as above mentioned but CLAD and Ara-c were administered for 5 days while Cy was abandoned for its adverse cardiovascular reactions. All the 20 patients received peripheral blood stem cells for auto-HSCT. The median amount of infused mononuclear cell and CD34+ stem cell were 9.05×108/kg(range, 2.88 to 20.97) and 1.99×106/kg(range, 1.59 to 10.44), respectively. All the 20 patients achieved neutrophil and platelet engraftment with a median time of 13(range, 10 to 34) days and 27(range, 14 to 113) days, respectively. Three patients suffered from septicemia during neutropenia stage, 2 patients suffered from pulmonary infection, the others suffered from mild to moderate infection or gastrointestinal reaction after conditioning and all were relieved by anti-infection and other supportive treatment. None of the patients died of transplant related complications. From 2 months after auto-HSCT, the maintenance therapy with interleukin-2, interferon or azacitidine was performed for 7 patients with FLT3- ITD mutation negative, sorafeni were performed for 2 patient with FLT3 -ITD mutation positive. At a median follow-up of 25.5(range, 2.5 to 52.5) months,four patients relapsed after auto-HSCT at a median time of 8(range, 0.5 to 18.5) months. One patients died due to leukemia relapse at 18 months after auto-HSCT, the other 19 patients were all alive including 16 patients with MRD negative and the other 3 patients achieved MRD negative after allogeneic HSCT or maintenance therapy. The estimated 2-year survival, relapse, and disease-free survival rates were 93.3%, 22.9% and 77.1%, respectively.
Conclusion
The modified conditioning incorporating CLAD was safe and effective for auto-HSCT in acute myeloid leukemia which might be confirmed by more clinical studies.
Keyword(s): Acute myeloid leukemia, Autologous hematopoietic stem cell transplantation, Cladribine, Conditioning