Clinical analysis of reduced intensity allogeneic hematopoietic stem cell transplantation for relapsed or refractory acute myeloid leukemia in elderly patients

Objective To explore the effect and feasibility of reduced intensity allogeneic hematopoietic stem cell transplantation (allo-HSCT) in the treatment of relapsed or refractory acute myeloid leukemia (AML) in elderly patients.Methods Six elderly patients with relapsed or refractory AML received reduced intensity conditioning allo-HSCT from January 2012 to January 2014 in Beijing Military Region General Hospital,including 5 males and 1 females,aged from 61 to 68 years old with mean age of 64.6 years old.Donors received granulocyte colony-stimulating factor to mobilize and used peripheral blood stem cell transplantation.Pretreatment scheme was reduced the strength of pretreatment for fludarabine combined with busulfex and cytarabine,cyclophosphamide.Preventive donor peripheral blood stem cell infusion was used after 3 months of transplantation and observed toxicity,GVHD and disease-free survival in patients after transplantation.Results All patients reached hematopoietic reconstitution,the average time were 21.5 d and 24.2 d respectively with neutrophils ≥0.5×109/L and platelets ≥20×109/L.Implantation was confirmed by the evidence of 100 ％ of donor hematopoiesis.With a median follow-up duration of 11.5 months (5～18 months),three cases occurred GVHD in all patients,one died of GVHD and other two cases died of relapse,the other three patients remained disease-free survival,the disease-free survival rate of 2-year was 50 ％,the longest disease-free survival time up to 30 months.Conclusion Reduced intensity allo-HSCT is an effective therapeutic method for relapsed or refractory AML in elderly patients. Key words: Leukemia, myelocytic, acute;  Transplantation conditioning;  Allogeneic hematopoietic stem cell transplantation;  Elderly;  Disease-free survival;  Graft vs host disease