Mitoxantrone and melphalan as a conditioning regimen for autologous peripheral blood stem cell transplantation in adults with acute myelogenous leukemia
Year: 2006
Type: article
Abstract: A variety of conditioning regimens are used for autologous hematopoietic stem cell transplantation in patients with acute myelogenous leukemia (AML). High dose mitoxantrone and melphalan (Mito/Mel) has been reported as an effective and well-tolerated regimen for autologous peripheral blood stem cell transplantation (APBSCT) in patients with lymphoma. We review our experience with Mito/Mel as a conditioning regimen in 18 adult patients (12 female, 6 male) with intermediate or high risk AML who underwent APBSCT. All patients received anthracycline based induction and consolidation chemotherapy prior to APBSCT. At the time of transplantation, 16 patients were in first complete remission (CR) and 2 patients were in second CR. Median age at the time of APBSCT was 51 years (range 19–70). All patients received a conditioning regimen consisting of mitoxantrone 60 mg/m2 IV on day −4 and melphalan 180 mg/m2 IV on day −1, followed by infusion of autologous peripheral blood stem cells on day 0. Rapid hematologic recovery was observed in most patients, with values of ANC >500 and platelet >20,000 being reached at 13 and 16 days, respectively. Cardiac toxicity was monitored by echocardiogram. All patients demonstrated a normal left ventricular ejection fraction (LVEF) prior to receiving the conditioning regimen. There were no deaths attributable to heart failure. A significant decline in LVEF developed in only one patient who was over age 60 with underlying diabetes and hypertension. Ninety-four percent of patients survived the first 100 days following transplant. To date, 7 patients are alive and in remission at 2 to 7 years since disease onset, with no patients lost to follow-up. The 3-year failure-free and overall survival are 44% and 55%, respectively. We conclude that high dose mitoxantrone and melphalan is an effective and easily administered conditioning regimen with a low risk of significant cardiac toxicity despite prior treatment with anthracycline based chemotherapy, and thus is a safe regimen for APBSCT in adults with AML.
Institutions: Tufts Medical Center, Beth Israel Deaconess Medical Center
Language: English
Subfield: Hematology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,650
OpenAlex ID: W1965390065