Researchers from Marseille in France have reported a 76% 2-year, leukemia-free survival in 33 adults (median age of 52 years; oldest 60 years) with acute myeloid leukemia (AML) and treated with a reduced-intensity allogeneic stem cell transplant? after remission induction and consolidation.
The details of this phase II study appeared in the November 1, 2005, issue of Cancer .
The role of allogeneic stem cell transplantation in the treatment of younger patients with AML who relapse is well established. However, the role of allogeneic stem cell transplantation in patients in first remission is still evolving. Current data suggests that young patients with intermediate risk factors benefit from an allogeneic stem cell transplant in first remission while good risk and poor risk patients do not. For good risk patients the best strategy is to transplant only those patients who relapse. For poor risk patients there has been no improvement in outcome over the past 3 decades with or without a transplant. This is especially true for older patients who have more aggressive disease and often have significant co-morbidities interfering with optimal aggressive therapy.
Sixty-four percent of 33 patients (median age 52 years) in study were characterized as high risk for relapse. All patients had achieved a complete remission to induction therapy and had received two consolidation chemotherapy courses. Thirteen patients also received an autologous stem transplant following high-dose melphalan treatment. Transplant-related mortality was 9% and 18% relapsed. With a median follow-up of 18 months 26 patients survive and 24 of these have not relapsed. No patient with chronic graft-versus host disease (GVHD) had a relapse while 44% without chronic GVHD relapsed.
These data suggests that immunotherapy in the form of a reduced-intensity allogeneic stem cell transplant can be used to eradicate minimal residual disease in patients with AML with acceptable toxicity.
Reference: Blaise DP, Briron JM, Faucher C, et al. Reduced intensity conditioning prior to allogeneic stem cell transplantation for patients with acute myeloblastic leukemia as first-line treatment. Cancer . 2005;104:1931-1938.
? Allogeneic stem cell transplants refer to stem cells that are taken from one person and given to another. With these transplants, the donor’s cells must match the recipient’s tissue type (much like a blood transfusion needing to match the blood type of the person receiving it).
In many cases, the stem cell donor is related to the recipient, like a brother or sister. However, stem cells from unrelated donors can be used if the tissue types matches. It may also be possible to use cells from banked cord blood.