TRANSPLANTATION OF AUTOLOGOUS PERIPHERAL-BLOOD PROGENITOR CELLS PROCURED AFTER HIGH-DOSE CYTARABINE-BASED CONSOLIDATION CHEMOTHERAPY FOR ADULTS WITH ACUTE MYELOGENOUS LEUKEMIA IN FIRST REMISSION

The purpose of the study was to evaluate the feasibility and efficacy of high-dose cytarabine-anthracycline consolidation chemotherapy follo wed by autologous transplantation of chemotherapy/rHuG-CSF-mobilized p eripheral blood progenitor cells for adult patients with acute myeloge nous leukemia in first remission. Fifty-nine consecutive patients (med ian age 45, range 18-69) with acute myelogenous leukemia in first remi ssion were enrolled on a study of high-dose cytarabine-mitoxantrone co nsolidation chemotherapy used as a method of in vivo purging for the p urpose of autologous peripheral blood progenitor cell transplantation. A median of 7 x 10(8) peripheral blood mononuclear cells/kg were infu sed 1 day after preparative conditioning with 11.25 Gy total body irra diation and cyclophosphamide (120 mg/kg). Forty-six patients received myeloablative chemo-radiotherapy followed by the infusion of chemother apy/rHu-G-CSF-mobilized autologous peripheral blood progenitor cells. The median time to both neutrophil and platelet recovery from transpla nt was 15 days (range, 11-36 and 5-253 + days, respectively). After a median follow-up of 27 months, 31 patients remain alive with 27 in com plete remission. Median remission duration for all eligible patients i s 12 months, and actuarial leukemia-free survival at 3 years is 42 +/- 14%. The actuarial risk of relapse is 54 +/- 15%. Toxicity of autolog ous peripheral blood progenitor cell transplant included treatment-rel ated death in two patients and grade III/IV organ toxicity in six. Adv anced age was a negative prognostic factor for leukemia-free survival. Our results demonstrate that autologous transplantation of chemothera py-mobilized peripheral blood progenitor cells is feasible in an unsel ected population of adult patients with acute myelogenous leukemia in first remission producing improved leukemia-free survival with minimal toxicity.