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The effect of graft purging with 4-hydroperoxycyclophosphamide in autologous bone marrow transplantation for acute myelogenous leukemia.

Abstract：

BACKGROUND:Autologous bone marrow transplantation is an important therapy for patients with acute myelogenous leukemia (AML). However, leukemia in the graft may contribute to posttransplant relapse. Treatment of the graft with 4-hydroperoxycyclophosphamide (4HC) is sometimes used to decrease numbers of infused leukemia cells (4HC purging). No large controlled trials evaluating efficacy and toxicity of 4HC purging are reported. METHODS:We studied 294 patients reported to the Autologous Blood and Marrow Registry receiving either a 4HC-purged (n = 211) or unpurged (n = 83) autograft for AML in first (n = 209) or second (n = 85) remission. Analyses were restricted to patients transplanted less than 6 months after achieving remission. Using Cox proportional hazards regression, we compared time to treatment failure (death or relapse, inverse of leukemia-free survival) after 4HC-purged vs unpurged transplants while controlling for important prognostic factors. RESULTS:Median duration of posttransplant neutropenia was 40 (range, 10-200) days after 4HC-purged transplants and 29 (9-97) days after unpurged transplants (p < 0.01). Transplant-related mortality was similar in the two groups. In multivariate analysis, patients receiving 4HC-purged transplants had lower risks of treatment failure than those receiving unpurged transplants (relative risk, 0.69, p = 0.12 in the first posttransplant year; relative risk, 0.28, p < 0.0001 thereafter). Adjusted three-year probabilities of leukemia-free survival (95% confidence interval) were 56% (47-64%) and 31% (18-45%) after 4HC-purged and unpurged transplants in first remission, respectively. Corresponding probabilities in second remission were 39% (25-53%) and 10% (1-29%). CONCLUSION:Grafts purged with 4HC are associated with higher leukemia-free survival after autologous bone marrow transplants for AML.

journal_name

Exp Hematol

journal_title

Experimental hematology

authors

Miller CB,Rowlings PA,Zhang MJ,Jones RJ,Piantadosi S,Keating A,Armitage JO,Calderwood S,Harris RE,Klein JP,Lazarus HM,Linker CA,Sobocinski KA,Weisdorf D,Horowitz MM

doi

10.1016/s0301-472x(01)00732-9

keywords:

subject

Has Abstract

pub_date

2001-11-01 00:00:00

pages

1336-46

issue

11

eissn

0301-472X

issn

1873-2399

pii

S0301-472X(01)00732-9

journal_volume

29

pub_type

杂志文章,多中心研究

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