New strategies in the treatment of acute myelogenous leukemia: Mobilization and transplantation of autologous peripheral blood stem cells in adult patients

During the last decade high-dose Ara-C (HIDAC; single doses of 3 g/m(2)) an d autologous stem cen transplantation have been increasingly used as postre mission therapy in adult acute myelogenous leukemia (AML). Controlled clini cal trials have demonstrated a long-term disease-free survival of 40%-50% f or patients treated with at least two courses of HIDAC. Other studies have demonstrated that postremission autologous bone marrow transplantation resu lts in a disease-free survival equal to or better than conventional chemoth erapy. However, autotransplantation with mobilized peripheral blood stem ce lls (PBSC) would not be preferred instead of autologous bone marrow, due to the shorter hematopoietic reconstitution period, The results reviewed in t he present article suggest that HIDAC and autologous PBSC transplantation c an be combined in the postremission treatment of adult AML, and this combin ation therapy may also reduce minimal residual disease and the risk of post transplant relapse. From the available studies it cannot be concluded wheth er graft purging further reduces the relapse risk. However, the possible ad vantage of combination therapy with repeated courses of HIDAC and autologou s PBSC transplantation needs to be demonstrated in prospective clinical tri als before it can be recommended as a part of the routine treatment in AML.