Allogeneic hematopoietic stem cell transplantation with pretreatment added to idarubicin for treatment of refractory acute myeloid leukemia

Objective To explore the effect and feasibility with pretreatment added to idarubicin of allogeneic hematopoietic stem cell transplantation (allo-HSCT) in the refractory acute myeloid leukemia.Methods 27 patients (13 males and 14 females) with refractory acute myeloid leukemia received allogeneic hematopoietic stem cell transplantation from August 2010 to December 2012 in the Beijing Military Region General Hospital,with the FAB classification of M1 1 case,M2 10 cases,M3 1 case,M4 1 case,M5 11cases and M6 3 cases.However 18 of the 27 cases were the recurrence,and 9 cases were the second or more remission.22 cases were treated with transplantation of the bone marrow combining peripheral blood of donors.5 cases were treated with peripheral blood.All patients were treated with pretreatment consisting of cytarabine,busulfan,fludarabine and added to idarubicin (15 mg/m2,-10,-9,-8 d).Graft-versus-host disease (GVHD) was prevented by combining variety of immunosuppressants including cyclosporin A (CsA),methotrexate (MTX),and anti-thymocyte immunoglobulin (ATG).The regimen-associated side effect,incidence of GVHD and disease-free survival probabilities were observed after HSCT.Results All of the 27 patients acquired hematopoietic reconstitution.Conditioning regimen was well tolerated and no pre-treatment-related adverse reactions or cardiac toxicity events to early death happened.The bone morrow initial engraftment time was 11 to 23 days,with an average time of 15 days.The median follow up time was 12 months (5-33months),13 patients had experience of acute GVHD,and 11 patients had experience of chronic GVHD.2patients died of GVHD.13 cases had serious infection and 1 case died of infection,and 5 of the 7 recurrence cases died of relapse.The rest 19 patients were alive.All patients treatment-related mortality,relapse-related mortality and overall survival rates were 11.1％ (3/27),18.5 ％ (5/27) and 70.4 ％ (19/27),respectively.Conclusion The patient is well tolerated conditioning regimen with pretreatment added to idarubicin,which is feasible and safe.It can reduce the refractory leukemia relapse rate or improve long-term survival after transplantation without incrasing complications. Key words: Leukemia, myeloid, acute;  Hematopoietic stem cell transplantation, allogeneic; Idarubicin;  Recurrence;  Refractory