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Background: Good risk AML patients (core binding factor AML; diploid cytogenetics AML without Flt-3 ITD) are frequently consolidated with 3-4 cycles of high dose cytarabine (HIDAC) after induction of remission. About 50% of these patients relapse resulting in long term survival of 40-60% (Marcucci et al JCO vol. 23 :5705-5717; 2005).
Materials and Methods: We retrospectively analyzed the outcomes of patients with good risk AML who underwent ASCT since 2009.
Results: 17 patients (10 males; 7 females) were identified in the database. Their median age was 60 years (range 29-80). All patients had received HIDAC based induction followed by at least one cycle of HIDAC based consolidation. Mobilizing chemotherapy was HIDAC (1-3 grams/m2 for 6-8 doses)/Etoposide(15-40mg/kg) in 16 patients and growth factor alone in one patient. Median time from diagnosis to ASCT was 4.2 (range 3.6-7) months. Preparative regimen for ASCT was Busulfan (3.2mg/kg x 4)/Etoposide (60 mg/kg) in 12 patients and high dose melphalan in 5 patients. The median CD34 cells infused was 4.9 x 10e6/kg (range 2.8 to 15.9).All patients engrafted with a median time to neutrophil engraftment of 11 (range10-12) days. The median time to platelet engraftment was 20 (range15-40) days. The median length of inpatient stay during the ASCT admission was 14 (range 10-25) days. One patient died of progressive disease 14 months post ASCT. Two patients died in remission on day 53 (sepsis) and day 836 (unknown cause) post ASCT. Fourteen patients (82%) are currently alive in complete remission. at a median follow-up of 20 (range 1- 40) months post ASCT.
Conclusion: Consolidation of good risk AML patients with ASCT following induction of complete remission is safe and effective in preventing relapse in good risk AML patients.