Infusion of HLA-mismatched peripheral blood stem cells improves the outcome of chemotherapy for acute myeloid leukemia in elderly patients

• Published in: Blood Vol. 117; no. 3; pp. 936 - 941
• Main Authors: Guo, Mei, Hu, Kai-Xun, Yu, Chang-Lin, Sun, Qi-Yun, Qiao, Jian-Hui, Wang, Dan-Hong, Liu, Guang-Xian, Sun, Wan-Jun, Wei, Li, Sun, Xue-Dong, Huang, Ya-Jing, Qiao, Jun-Xiao, Dong, Zheng, Ai, Hui-Sheng
• Format: Journal Article
• Language: English
• Published: Washington, DC Elsevier Inc 20.01.2011; Americain Society of Hematology
• Subjects: Acute Disease; Adult; Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; Cytarabine - administration & dosage; Cytarabine - adverse effects; Female; Hematologic and hematopoietic diseases; Histocompatibility - immunology; Histocompatibility Testing; HLA Antigens - immunology; Humans; Infections - etiology; Leukemia, Myeloid - immunology; Leukemia, Myeloid - pathology; Leukemia, Myeloid - therapy; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Male; Medical sciences; Middle Aged; Mitoxantrone - administration & dosage; Mitoxantrone - adverse effects; Peripheral Blood Stem Cell Transplantation - methods; Transplantation Chimera - blood; Transplantation Chimera - immunology; Treatment Outcome; Human; Incompatibility; Acute myelogenous leukemia; Prognosis; Hematology; Hematopoietic cell; Malignant hemopathy; Blood; Chemotherapy; Treatment; Perfusion; Histocompatibility; Elderly; Cancer
• ISSN: 0006-4971; 1528-0020; 1528-0020
• DOI: 10.1182/blood-2010-06-288506

Treatment outcome of acute myeloid leukemia (AML) in elderly patients remains unsatisfactory. It has been shown that the infusion of granulocyte colony-stimulating factor–mobilized donor peripheral blood stem cells (G-PBSCs) can enhance graft-versus-leukemia effects and speed hematopoietic recovery. Fifty-eight AML patients aged 60-88 years were randomly assigned to receive induction chemotherapy with cytarabine and mitoxantrone (control group; n = 28) or it plus human leukocyte antigen–mismatched G-PBSCs (G-PBSC group; n = 30). Patients who achieved complete remission received another 2 cycles of postremission therapy with intermediate-dose cytarabine or it plus G-PBSCs. The complete remission rate was significantly higher in the G-PBSC group than in the control group (80.0% vs 42.8%; P = .006). The median recovery times of neutrophils and platelets were 11 days and 14.5 days, respectively, in the G-PBSC group and 16 days and 20 days, respectively, in the control group after chemotherapy. The 2-year probability of disease-free survival was significantly higher in the G-PBSC group than in the control group (38.9% vs 10.0%; P = .01). No graft-versus-host disease was observed in any patient. Persistent donor microchimerism was successfully detected in all of the 4 female patients. These results indicate that G-PBSCs in combination with conventional chemotherapy may provide a promising treatment method for AML in elderly patients.