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