DELAYED ENGRAFTMENT OF 4-HYDROPEROXYCYCLOPHOSPHAMIDE-PURGED AUTOLOGOUS BONE-MARROW AFTER INDUCTION TREATMENT CONTAINING MITOXANTRONE FOR ACUTE MYELOGENOUS LEUKEMIA

Citation
Le. Damon et al., DELAYED ENGRAFTMENT OF 4-HYDROPEROXYCYCLOPHOSPHAMIDE-PURGED AUTOLOGOUS BONE-MARROW AFTER INDUCTION TREATMENT CONTAINING MITOXANTRONE FOR ACUTE MYELOGENOUS LEUKEMIA, Bone marrow transplantation, 17(1), 1996, pp. 93-99
Citations number
22
Categorie Soggetti
Hematology,Oncology,Immunology,Transplantation
Journal title
ISSN journal
02683369
Volume
17
Issue
1
Year of publication
1996
Pages
93 - 99
Database
ISI
SICI code
0268-3369(1996)17:1<93:DEO4A>2.0.ZU;2-4
Abstract
We have previously documented that adults with de novo acute myelogous leukemia (AML) who are induced into first complete remission with mit oxantrone and high-dose cytarabine are more likely than those induced with daunorubicin and high-dose cytarabine to develop a bone marrow in jury pattern with delayed cytopenias after achieving initial complete remission, a phenomenon we have termed post-remission cytopenia syndro me. We therefore retrospectively compared the engraftment kinetics of mitoxantrone and daunorubicin patients following 4-hydroperoxycyclopho sphamide (4HC) purged autologous bone marrow transplant (ABMT) with bu sulfan-etoposide conditioning. Despite equivalent graft colony forming units granulocyte macrophage (CFU-GM), mitoxantrone patients (n = 13) took a median 7 weeks longer to achieve 1.0 x 10(9)/l granulocytes, 5 weeks longer to achieve platelet transfusion independence, and 10 wee ks longer to achieve red blood cell transfusion independence, and requ ired more platelet transfusions (P = 0.008), than daunorubicin patient s (n = 13). Patients experiencing the postremission cytopenia syndrome (n = 11) had significantly slower engraftment than those not experien cing the syndrome (n = 15; P less than or equal to 0.04). Two mitoxant rone and five daunorubicin patients have relapsed after ABMT (P = 0.38 ). We conclude that the type of induction chemotherapy used in untreat ed adults with de novo AML can influence subsequent engraftment after 4HC-purged ABMT. We believe that mitoxantrone combined with high-dose cytarabine should be avoided as induction chemotherapy in patients for whom 4HC-purged ABMT is planned.