Consolidation treatment with autologous peripheral blood progenitor cell transplantation in acute myeloid leukemia: a single center experience

Several trials have suggested that intensive post-remission therapy may pro long the duration of complete remission (CR) in acute myeloid leukemia (AML ). The purpose of this study was to evaluate the feasibility and the effica cy of high-dose cytarabine (HiDAC) consolidation chemotherapy followed by h igh-dose therapy and autologous infusion of peripheral blood progenitor cel ls (PBPC) mobilized by G-CSF in adult patients with AML in first CR. Fiftee n consecutive AML patients underwent HiDAC consolidation chemotherapy, used as a method of in vivo purging, followed by G-CSF for the purpose of autol ogous PBPC collection. Eleven patients collected a median of 6.9x10(8)/kg p eripheral blood mononuclear cells (MNC) (range 2.9-23) and a median of 6.67 x10(6)/kg CD34+ cells (range 1.8-33.5) with a median of two aphereses (rang e 1-3). Two patients did not mobilize and two obtained an inadequate number of progenitor cells. The 11 patients with adequate collections received my eloablative chemotherapy followed by the infusion of PBPC. The median numbe r of days to recover neutrophils and platelets was 12 and 13, respectively. After a median follow-up of 28.7 months (range 17.2-43.4), five out of 11 patients who underwent PBPC transplantation are still in CR, five have died in first relapse and one is alive in CR after relapse treated with salvage therapy and second PBPC infusion. These results demonstrate that HiDAC con solidation chemotherapy followed by autologous PBPC transplantation is a fe asible procedure with minimal toxicity. Randomized studies should be perfor med to evaluate whether this form of consolidation may produce a significan t improvement in leukemia-free survival.