SOURCE OF STEM CELLS AND RELAPSE AFTER TRANSPLANTATION IN AML

Higher Incidence of Relapse With Peripheral Blood Rather Than Marrow As a Source of Stem Cells in Adults With Acute Myelocytic Leukemia Autografted During the First Remission

Norbert-Claude Gorin, Myriam Labopin, Didier Blaise, Josy Reiffers, Giovanna Meloni, Mauricette Michallet, Theo de Witte, Michel Attal, Bernard Rio, Francois Witz, Loic Fouillard, Roel Willemze, Vanderson Rocha

From the Hôpital Saint Antoine, Department of Hematology; Acute Leukemia Working Party, European Cooperative Group for Blood and Marrow Transplantation Paris Office; Faculté de Médecine, St Antoine Université Pierre et Marie Curie Paris 6 and Unité Ministerielle de Recherche (UMR) S-893; Hotel Dieu, Department of Hematology; Hôpital Saint Louis, Department of Hematology – Bone Marrow Transplantation (BMT) 1, Paris; Institut Paoli Calmettes, Unité de transplantation et de thérapie cellulaire; L'Institut National de la Santé et de la Recherche Médicale UMR 599, Marseille; Centre Hospitalier Universitaire (CHU), Bordeaux; Hôpital Haut-Leveque, Pessac; Hôpital Edouard Herriot, BMT Unit Pavillon E, Lyon; Hôpital Purpan CHU, Department of Hematology, Toulouse; Hôpital de Brabois, Hématologie et Médecine Interne, Nancy, France; University La Sapienza, Dipartimento di Biotecnologie Cellulari e Ematologia, Rome, Italy; University Medical Center Saint Radboud, Department of Haematology, Nijmegen; and the Leiden University Medical Center, Department of Hematology, Leiden, the Netherlands.

Corresponding author: Norbert Claude Gorin, MD, Hopital Saint-Antoine, 184 rue du Faubourg Saint-Antoine, 75012 Paris, France; email: norbert-claude.gorin@sat.aphp.fr.

Purpose The cell source for autologous stem cell transplantation has shifted from bone marrow (BM) to peripheral blood (PB). In acute myelocytic leukemia (AML), for patients who receive transplants during first complete remission (CR1), no prospective randomized study has compared relapse incidence (RI) to cell source.

Patients and Methods We analyzed 2,165 patients who received autografts (1,607 PB and 558 BM) from 1994 to 2006 and were reported to the European Cooperative Group for Blood and Marrow Transplantation with complete research data. Relative to the time of CR1, PB transplants were performed earlier than BM transplants. Because a poorer outcome was associated with a shorter interval from CR1 to transplantation, patients were divided into three groups: BM, early PB ( 80 days after CR1), and late PB (> 80 days after CR1) transplantation.

Results In a multivariate analysis adjusted for differences between groups and center, RI was higher with both early PB (56% ± 3%; hazard ratio [HR], 1.45; 95% CI, 1.11 to 1.9; P = .006) and late PB transplantation (46% ± 2%; HR, 1.3; 95% CI, 1.06 to 1.59; P = .01) as compared with BM transplantation (39% ± 2%). This translated into a significantly worse leukemia-free survival (LFS) for early PB transplantation (36% ± 3%; HR, 0.75; 95% CI, 0.58 to 0.96; P = .02) and a trend for a poorer LFS for late PB (46% ± 2%; HR, 0.84; 95% CI, 0.7 to 1.01; P = .06) as compared with BM (52% ± 2%).

Conclusion For patients with AML in CR1, risk of relapse is greater with PB transplantation rather than BM, independent of the interval from CR1 to transplantation