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Introduction Although the clinical application of autologous hematopoietic stem cell transplantation (auto-HSCT) in the treatment of acute myeloid leukemia (AML) patients was once sluggish, auto-HSCT has no plant-versus-host disease (GVHD) and no human leukocyte antigen (HLA) matching.
It is still an important consolidation treatment plan for patients with standard-risk, intermediate-risk and some special types of AML in the first complete remission (CR1)
.
Cladribine (CLAD) combined with other drug pretreatment can reduce the recurrence rate and improve overall survival after allogeneic hematopoietic stem cell transplantation (allo-HSCT) in patients with hematologically unresolved AML
.
However, there are few studies on the effect of CLAD preconditioning on auto-HSCT in AML patients
.
Scholars from the Hospital of Hematology, Chinese Academy of Medical Sciences explored the effect of CLAD combined with busulfan (Bu)/cyclophosphamide (Cy) preconditioning on auto-HSCT in patients with AML
.
The results were selected for the poster presentation of the 48th European Society of Blood and Marrow Transplantation (EBMT) annual meeting in 2022.
The editor will organize the main contents as follows for the reference of readers
.
Methods This study assessed the outcomes of 22 adult AML patients who underwent auto-HSCT at the Hospital of Hematology, Chinese Academy of Medical Sciences from September 2016 to May 2021
.
There were 13 males and 9 females with a median age of 32 years (range: 15-54 years)
.
The median course of chemotherapy before Auto-HSCT was 4 courses (range: 2-9 courses), and all patients were minimal residual disease (MRD) negative before auto-HSCT
.
14 patients were treated with myeloablative preconditioning: Bu 3.
2 mg/kg/d*3, Cy 40mg/kg/d*2, CLAD 5 mg/m2/d*3, cytarabine (Ara-c) 2g/ m2/d*3 or idarubicin 12mg/m2/d*3
.
Eight patients were pretreated with the same regimen, but Cy was changed to CLAD and Ara-c for 5 days due to adverse cardiovascular reactions caused by Cy
.
Results All 22 patients received auto-HSCT of peripheral blood stem cells
.
The median amount of injected monocytes was 10.
00×108/kg (range: 2.
88-20.
97×108/kg) and the median amount of CD34+ stem cells was 1.
89×106/kg (range: 1.
59-10.
44×106/kg)
.
The median time to neutrophil engraftment in 22 patients was 13 days (range: 10-34 days) and the median time to platelet engraftment was 28 days (range: 14-113 days)
.
4 patients developed sepsis during the neutropenic phase, 2 patients developed pulmonary infection, and the remaining patients developed mild to moderate infections or gastrointestinal reactions after pretreatment, which were relieved by anti-infection and supportive care
.
No patient died from transplant-related complications
.
After 2 months of Auto-HSCT, 7 FLT3/ITD-negative patients were maintained with interleukin-2, interferon or azacitidine, and 1 FLT3/ITD-positive patient was maintained with sorafenib
.
Fourteen patients received no maintenance therapy after auto-HSCT
.
With a median follow-up time of 29.
5 months (range: 4-60 months), 3 patients developed recurrence after auto-HSCT, with recurrence after a median time of 6 months (range: 0.
5-10 months)
.
Only one patient died of leukemia relapse at 18 months
.
One patient who relapsed after auto-HSCT achieved MRD negativity after maintenance therapy, and the remaining patients who relapsed successfully received allo-HSCT
.
The estimated 2-year survival rate, recurrence rate, and disease-free survival rate were 94.
1%, 14.
7%, and 85.
3%, respectively
.
The study concluded that adding CLAD for pretreatment before auto-HSCT is safe and effective, but the number of samples in this study is small, and more clinical studies are needed to confirm in the future
.
References: Y.
Shi, G.
Zhang, Y.
He, et al.
CLADRIBINE ADDED TO MODIFIED BUSULFAN/CYCLOPHOSPHAMIDE CONDITIONING FOR AUTOLOGOUS HEMATOPOIETIC STEM CELL TRANSPLANTATION IN ACUTE MYELOID LEUKEMIA.
The 48th Annual Meeting of the EBMT.
Abstract P049.
Edited by: Wenting Review: Mia Typesetting: Wenting pokes "read the original text", let's make progress together
It is still an important consolidation treatment plan for patients with standard-risk, intermediate-risk and some special types of AML in the first complete remission (CR1)
.
Cladribine (CLAD) combined with other drug pretreatment can reduce the recurrence rate and improve overall survival after allogeneic hematopoietic stem cell transplantation (allo-HSCT) in patients with hematologically unresolved AML
.
However, there are few studies on the effect of CLAD preconditioning on auto-HSCT in AML patients
.
Scholars from the Hospital of Hematology, Chinese Academy of Medical Sciences explored the effect of CLAD combined with busulfan (Bu)/cyclophosphamide (Cy) preconditioning on auto-HSCT in patients with AML
.
The results were selected for the poster presentation of the 48th European Society of Blood and Marrow Transplantation (EBMT) annual meeting in 2022.
The editor will organize the main contents as follows for the reference of readers
.
Methods This study assessed the outcomes of 22 adult AML patients who underwent auto-HSCT at the Hospital of Hematology, Chinese Academy of Medical Sciences from September 2016 to May 2021
.
There were 13 males and 9 females with a median age of 32 years (range: 15-54 years)
.
The median course of chemotherapy before Auto-HSCT was 4 courses (range: 2-9 courses), and all patients were minimal residual disease (MRD) negative before auto-HSCT
.
14 patients were treated with myeloablative preconditioning: Bu 3.
2 mg/kg/d*3, Cy 40mg/kg/d*2, CLAD 5 mg/m2/d*3, cytarabine (Ara-c) 2g/ m2/d*3 or idarubicin 12mg/m2/d*3
.
Eight patients were pretreated with the same regimen, but Cy was changed to CLAD and Ara-c for 5 days due to adverse cardiovascular reactions caused by Cy
.
Results All 22 patients received auto-HSCT of peripheral blood stem cells
.
The median amount of injected monocytes was 10.
00×108/kg (range: 2.
88-20.
97×108/kg) and the median amount of CD34+ stem cells was 1.
89×106/kg (range: 1.
59-10.
44×106/kg)
.
The median time to neutrophil engraftment in 22 patients was 13 days (range: 10-34 days) and the median time to platelet engraftment was 28 days (range: 14-113 days)
.
4 patients developed sepsis during the neutropenic phase, 2 patients developed pulmonary infection, and the remaining patients developed mild to moderate infections or gastrointestinal reactions after pretreatment, which were relieved by anti-infection and supportive care
.
No patient died from transplant-related complications
.
After 2 months of Auto-HSCT, 7 FLT3/ITD-negative patients were maintained with interleukin-2, interferon or azacitidine, and 1 FLT3/ITD-positive patient was maintained with sorafenib
.
Fourteen patients received no maintenance therapy after auto-HSCT
.
With a median follow-up time of 29.
5 months (range: 4-60 months), 3 patients developed recurrence after auto-HSCT, with recurrence after a median time of 6 months (range: 0.
5-10 months)
.
Only one patient died of leukemia relapse at 18 months
.
One patient who relapsed after auto-HSCT achieved MRD negativity after maintenance therapy, and the remaining patients who relapsed successfully received allo-HSCT
.
The estimated 2-year survival rate, recurrence rate, and disease-free survival rate were 94.
1%, 14.
7%, and 85.
3%, respectively
.
The study concluded that adding CLAD for pretreatment before auto-HSCT is safe and effective, but the number of samples in this study is small, and more clinical studies are needed to confirm in the future
.
References: Y.
Shi, G.
Zhang, Y.
He, et al.
CLADRIBINE ADDED TO MODIFIED BUSULFAN/CYCLOPHOSPHAMIDE CONDITIONING FOR AUTOLOGOUS HEMATOPOIETIC STEM CELL TRANSPLANTATION IN ACUTE MYELOID LEUKEMIA.
The 48th Annual Meeting of the EBMT.
Abstract P049.
Edited by: Wenting Review: Mia Typesetting: Wenting pokes "read the original text", let's make progress together
