Peripheral blood stem cell transplantation for patients with acute leukemia：clinical effects analysis in 50 cases

Abstract:

Objective：To evaluate the therapeutic effect of peripheral blood stem cell transplantation（PBSCT） in the treatment of acute leukemia（AL），to discuss advantages and disadvantages of allogeneic PBSCT（Allo-PBSCT） and autologous PBSCT（Auto-PBSCT） and to choose the appropriate preparative transplantation regimen. Methods：All fifty patients with AL underwent PBSCT from 2004 to 2012 in our hospital were retrospectively analyzed including 21 male and 29 female. Twenty－eight patients were treated with Allo-PBSCT and 22 with Auto-PBSCT. Effects of transplantation and complications were analyzed. Differences in transplantation relapse rate，disease-free survival（DFS） and transplant related mortality（TRM） were compared. Preparative regimen related death and suc－cess rate were analyzed. Results：No pretreatment scheme related death was occurred except 2 cases of MAC（melphalan+Cytarabine+cyclophosphamide） preparative regimen implanted failure. Forty－eight patients engrafted successfully with transplant success rate of 96%. Median time of white blood cell>0.5×109/L was 11.3 d（（7-24） d） and platelets>20×109/L was 14.3 d（（5-44） d）. Allo-PBSCT and Auto-PBSCT related death cases were 8 cases and 3 cases respectively with TRM of 28.6% and 15.0%，respectively. During the follow-up，accumulative DFS for Allo-PBSCT and Auto-PBSCT were 46.4% and 35.0% respectively；accumulative relapse rates were 25.0% and 55.0%，respectively. During follow-up，overall survival（OS） rates of Allo-PBSCT and Auto-PBSCT were 57.1% and 50.0%，respectively. Among patients under the condition of complete remission at first course（CR1） and complete remission after two or more course or non-remission before transplantation，OS rates were 61.5%，53.3% and 45.5%，55.6%；DFS were 46.2%，46.7% and 27.3%，44.4%；death rates were 38.5%，46.7% and 54.5%，44.4%，respectively after transplantation. Conclusions：PBSCT is effective in the treatment of AL. Effect is better for patients under the condition of CR1 before transplantation. Relapse rate is lower，long-term DFS is higher and transplant related complications are more in Allo-PBSCT than in Auto-PBSCT. Optimization of preparative regimen is the key to improve transplantation efficacy，preparative regimen based on busulfan/cyclophosphamide regimen has a better effect of pulp and tolerance.