Autologous stem cell transplantation with moderate dose of Idarubicin and Busulphan as conditioning regimen in acute myelogenous leukemia

Background: Over 50% of patients with AML still relapse after autologous stem cell transplantation. We investigated the efficacy and feasibility of a new conditioning regimen consisting of a moderate dose of Idarubicine plus conventional dose of oral Busulfan in patients undergoing autologous transplantation without favorable cytogenitic state and high dose therapy with Cytarabine or other drugs. Methods: Ten Patients were given three days of bolus infusion of IDA followed by four days of oral Busulfan as conditioning regimen. Unpurged peripheral blood stem cells were used in all cases. All the cases were in first complete remission (CR1). The reasons for the selection of these patients in the first remission were that they had not received high dose chemotherapy or did not have available cytogenitic state. Results: The transplant related mortality occurred in one case (refactory thrombocytopenia, leading to CNS hemorrhage). The median CD34+ cell infused was 8Ï106/kg. The median days to neutrophil recovery > (0.5 Ï 10 9) and platelet recovery > (20 Ï10 9/kg) were +9 days (4-12 days); +16 (2-30 days) respectively. The patients needed transfusion of a median of 15 platelet units and 7 blood units, respectively. Six out of 10 patients (60%) had variable grades of mucositis (three cases had grade III, two grade II and one case grade I). After a median follow up of 48 months from ASCT, 8 patients out of 10 (80%) were alive in continuous complete remission. One case had relapse after 6 months of transplantation. Conclusion: The findings of the study demonstrated the efficacy and feasibility of a conditioning regimen based on a moderate dose of IDA plus Busulphan in AML. The results concerning anti-leukemic efficacy are promising but need to be confirmed on larger series.