Transplantation of peripheral blood stem cells mobilized by intensified consolidation and granulocyte colony-stimulating factor in acute leukemia

The purpose of this study was to evaluate the feasibility and efficacy of a utologous transplantation of peripheral blood stem cells (PBSC) mobilized w ith high-dose consolidation chemotherapy and granulocyte colony-stimulating factor in patients with acute myelogenous leukemia (AML). Twenty patients received myeloablative chemotherapy or chemo-radiotherapy including total b ody irradiation followed by the infusion of PBSC. PBSC were collected by la rge-volume leukaphereses. The mean number of mononuclear cells and CD34-pos itive cells infused were 7.2 x 10(8)/kg (range, 2.2-16.6), and 6.6 x 10(6)/ kg (range, 2.1-27.7), respectively. Engraftment failure was not seen in the enrolled patients. The median time to neutrophil (greater than or equal to 500/muL) and platelet recovery (greater than or equal to 50,000/muL) from the transplant was 12 days (range, 8-20) and 28 days (range, 10-600), respe ctively. The 2-year probability of disease-free survival (DFS) and relapse were 43% and 57% for patients with AML transplanted in first complete remis sion (CR1). The outcome of the patients transplanted in the advanced status was significantly worse than the patients transplanted in CR1 (P=0.04). Mo st relapses occurred within 1 year after transplantation. Fatal hepatic ven o-occlusive disease was observed in one case. Other transplantation-related toxicities were mild. Our results demonstrated that autologous transplanta tion of high-dose consolidation chemotherapy-mobilized peripheral blood pro genitor cells is feasible in the patients with AML in CR1. To further reduc e the risk of leukemia relapse, much effort should be contributed to the fi eld of ex vivo purging and post-transplant immunotherapy.