THE EFFICACY OF HIGH-DOSE CONSOLIDATION AND AUTOLOGOUS BONE MARROW TRANSPLANTATION IN FIRST REMISSION OF ACUTE MYELOID LEUKEMIA

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Abstract

Introduction. The question of the most adequate treatment strategy of AML in cases when it is impossible to perform allogeneic HSCT because of any reason still remains open.

The aim of this study was to assess the long-term survival of patients with AML who received chemotherapy (CT) or autologous HSCT as consolidation in the first remission of the disease. It was included 135 patients aged 18 to 67 years, with a verified diagnosis of AML (except FAB M3) in the study. Of these, 100 patients received only CT, 35 patients received consolidation with autologous bone marrow transplantation. Patients who achieved remission after completion of induction CT courses received one of three treatment options as consolidation: 1) chemotherapy of standard-intensity (sCT), 2) high-dose chemotherapy (HDCT), 3) autologous HSCT (autoHSCT) conducted after 1–2 courses of high-dose CT. Adverse prognostic factors were identified as: age over 40 years, hyperleucocytosis more than 50,0 × 10 9/L and unfavorable cytogenetic and molecular-biological risk group.

Materials and methods. Depending on the number of prognostic factors at the onset of disease relapse-free survival (RFS) was 47 % in their absence, 45 % in the presence of 1 factor, in the presence of 2 factors – 14 % (p = 0,000), regardless of the variant of consolidation therapy (sCT, HDCT, autoHSCT). A high level of white blood cells adversely affects OS (38 % vs. 22 %) and increases the frequency of relapse (52 % vs. 69 %) when performing only CT (sCT and HDCT). At initial white blood cells level more than 50,0 × 10 9/L the 5-year OS was 60 % when performing both autoHSCT and HDCT. Performance of autoHSCT at failure to achieve remission after the 1st induction course CT is associated with the best 2-year OS (62 % vs. 35 %, p = 0,05), EFS (50 % vs. 22 %, p = 0,05) and RFS (50 % vs. 37 %, p = 0,05) in comparison with HDCT and sCT. In favorable cytogenetic risk group 5-year RFS was 80 % when performing autoHSCT and 67 % when performing HDCT; the 5-year OS was 80 % regardless of consolidation therapy option.

Conclusion. AutoHSCT is the preferred consolidation option in favorable risk group patients, and after failure to achieve remission after the 1st CT course.

About the authors

I. A. Samorodova

R.M. Gorbacheva Research Institute of Pediatric Oncology, Hematology and Transplantology, Pavlov First Saint Petersburg State Medical University;
City Clinical Hospital № 31

Author for correspondence.
Email: irdoc@mail.ru
ORCID iD: 0000-0001-9321-9084
6/8 L’va Tolstogo St., St. Petersburg 197022, 3, prospect Dinamo, St. Petersburg 197110
 Russian Federation

S. N. Bondarenko

R.M. Gorbacheva Research Institute of Pediatric Oncology, Hematology and Transplantology, Pavlov First Saint Petersburg State Medical University

6/8 L’va Tolstogo St., St. Petersburg 197022 Russian Federation

V. N. Ovechkina

R.M. Gorbacheva Research Institute of Pediatric Oncology, Hematology and Transplantology, Pavlov First Saint Petersburg State Medical University

6/8 L’va Tolstogo St., St. Petersburg 197022 Russian Federation

A. V. Klimovich

City Clinical Hospital № 31

3, prospect Dinamo, St. Petersburg 197110 Russian Federation

E. I. Podolceva

City Clinical Hospital № 31

3, prospect Dinamo, St. Petersburg 197110 Russian Federation

N. V. Medvedeva

City Clinical Hospital № 31

3, prospect Dinamo, St. Petersburg 197110 Russian Federation

A. S. Nizamutdinova

Aleksandrovskaya Hospital

4, prospect Solidarnosti, St. Petersburg 193312 Russian Federation

E. V. Karyagina

City Clinical Hospital № 15

4, Avangardnaya St., St. Petersburg 198205 Russian Federation

B. I. Smirnov

Saint Petersburg Electrotechnical University “LETI”

5, Professora Popova St. Petersburg 197376 Russian Federation

I. S. Moiseev

R.M. Gorbacheva Research Institute of Pediatric Oncology, Hematology and Transplantology, Pavlov First Saint Petersburg State Medical University

6/8 L’va Tolstogo St., St. Petersburg 197022 Russian Federation

L. S. Zubarovskaya

R.M. Gorbacheva Research Institute of Pediatric Oncology, Hematology and Transplantology, Pavlov First Saint Petersburg State Medical University

6/8 L’va Tolstogo St., St. Petersburg 197022 Russian Federation

B. V. Afanasyev

R.M. Gorbacheva Research Institute of Pediatric Oncology, Hematology and Transplantology, Pavlov First Saint Petersburg State Medical University

6/8 L’va Tolstogo St., St. Petersburg 197022 Russian Federation

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