Continuous infusion idarubicin and intravenous busulphan as conditioning regimen to autologous stem cell transplantation for patients with acute myeloid leukaemia

✍ Scribed by Felicetto Ferrara; Giuseppina Mele; Salvatore Palmieri; Mariangela Pedata; Carolina Copia; Cira Riccardi; Tiziana Izzo; Clelia Criscuolo; Pellegrino Musto

• Book ID: 102259808
• Publisher: John Wiley and Sons
• Year: 2009
• Tongue: English
• Weight: 111 KB
• Volume: 27
• Category: Article
• ISSN: 0278-0232
• DOI: 10.1002/hon.903

✦ Synopsis

Abstract

The current study aimed to evaluate the efficacy and toxicity of a combination of intravenous (iv) busulfan (Bu) and continuous infusion Idarubicin (IDA) as a conditioning regimen to autologous haematopoietic stem cell transplantation (ASCT) in patients with acute myeloid leukaemia (AML). The protocol included IDA at 20 mg/sqm daily as 3 days continuous infusion (from day −13 to −11) and intravenous BU at 3.2 mg/kg daily from day −5 to −2. Patients aged over 60 years received a reduced schedule (2 days IDA and 3 days BU at the same dose). Twenty‐five patients with a median age of 51 years (28–72) were enrolled. All patients received peripheral blood stem cells (PBSC). The median interval between diagnosis and ASCT was 4 months. The median number of CD34+ cells infused was 5.9 × 10E6/kg. The median number of days to PMN >500/cmm and platelets >20000/cmm was 10 and 13, respectively. In order to perform a comparison in terms of haematological and non haematological toxicity, a group of 30 patients, who were previously autografted after conditioning with IDA and oral Bu was considered. Selection of factors for a matched pair analysis included median age, percentage of subjects aged over 60 years, median CD34+ cell received, cytogenetic and molecular findings and per cent of secondary AML. As compared to previous series, the occurrence of severe mucositis was dramatically reduced (80% vs. 12%, p < 0.0001). In addition, need and duration of total parenteral nutrition (TPN), iv antibiotic therapy and hospitalization were also significantly reduced. We conclude that replacement of oral with intravenous BU results in a more favourable toxicity profile. A longer follow‐up is required to assess a potential advantage in terms of disease free survival (DFS). Copyright © 2009 John Wiley & Sons, Ltd.