Analysis Of Hematopoietic Stem Cell Transplantation For Patients With Denovo Acute Myeloid Leukemia In First Complete Remission

Objective To evaluate and compare the outcome of patients with denovo AML in CR1 undergone Auto-HSCT or HLA-identical Allo-HSCT. To analyze the leading cause of the mortality in such two groups, and propose the suggestion in the treatment. To estimate the effect and issues in two different purging methods of autologous bone marrow transplantation. Compare the effect of unrelated donor and sibling Allo-HSCT.Methods A total of 127 patients with denovo AML-CR1 underwent HSCT in our hospital from April 1985 to March 2008 were analyzed. 54 patients received Allo-HSCT and 73 received Auto-HSCT in CR1.The conditioning regimens mainly consisted of TBI/Cy(n=93), Bu/Cy(n=31) and MAC(n=3). In Allo-HSCT group, CsA, MTX, MMF, ATG were used for GVHD prophylaxis. CsA+MTX(n=13), CsA+MTX+MMF(n=41), CsA+MTX+MMF+ATG(n=9). Among Auto-HSCT group, 20 of 37 patients received autologous bone marrow transplantation, purged by YHPD(n=10) and LTBMC plus LMW NS(n=10).Results Myeloid reconstitution was achieved in 117 patients. After a median of 365 (range,74～8080) days follow-up, the probabilities of leukemia free survival (LFS) at 5 year were not significantly different in these two groups:52.4% for Auto-HSCT group and 56.6% for Allo-HSCT group (P>0.05). There was a lower cumulative RI [ 9.3% vs.30.1%, P<0.05 ] but a significantly higher cumulative TRM [27.9 % vs. 15%, P<0.05 ] in the Allo-HSCT group than in Auto-HSCT group. Among autologous bone marrow group, there was significant difference in LFS between the patients received purged auto grafts and unpurged autografts (55.0% vs.37.1%, P<0.05). Both Auto-HSCT and Allo-HSCT groups represented with a trend of decreasing TRM and arising LFS. Conclusion Both Auto-HSCT and Allo-HSCT are effctive therapeutic options, especially Auto-HSCT should not be underestimated. Bone marrow purging and post-transplantation immuno-therapy are good attemption to decrease relapse incidence. The long-term LFS of Auto-HSCT was comparable to that of Allo-HSCT in the management of patients with AML in CR1, because of lower therapy related toxicities.