PEDIATRIC AUTOLOGOUS STEM
CELL TRANSPLANTATION IN AML: PERIPHERAL BLOOD OR BONE MARROW
Anak S, Bilgen H, Yalman N,
Ozgenc S, Can E, Gedikoglu G
Istanbul
University, Istanbul School of Medicine, Dept. of Pediatric Hematology /
Oncology, Our-Children Leukemia BMT Center, Istanbul, TURKEY
In Our-Children Leukemia
Foundation BMT Center between 1992-2000 35 children (22F, 13 M median age
8) received auto SCT with the diagnosis of AML in CR1. The source of stem
cells was bone marrow in 20 and peripheral stem cells in 15. We have
evaluated the effect of the source of stem cell in outcome. The clinical
status, Fab types, time to SCT was similar ign two groups. The auto bone
marrow group consisted of 20 children (15 F, 5 M) with a meddian age of 10.
All the patients were in CR1 after the completion of MRC 10 AML protocol.
The time to transplant was 10 months. The marrows containing 3.2 x 10 8 /kg
mononuclear cells were given after a MultiDrug(Ara-C, ADR, BCNU, 6-TG, CTX)
regimen in 13, Bu-Cy in 5, TBI+CTX in 2 patients. The mean day of ANC >
500 + 19 days and mean day of plt>30.000/mm3 was 24 days. The duration
of hospitalization was 32 days (17-124 days). 10 patients relapsed (all
bone marrow) at the 6th months (3-11 mo).10(50%) patients are
alive & well (EFS: 49.59%)with a median follow up of 83 months. None of
the patients could get a remisison and died. The PBSCT group cons, sted of
7 girls and 8 boys with a median age of 8 years (3-17 years), all were in
CR1 after AML MRC 10 regimen. The mean CD34 + cells that were collected
after 2 consecutive days apheresis procedure using mobilization protocol of
CTX (4 gr/m2) + G-CSF+ GM-CSF was 4.3 x 10 6 / kg (2.8-12.6). The
conditioning regimen was Multi Drug in 3 and Bu-Cy in 12. Time to SCT was 6
months. The ANC > 550 was reached at day 11 and plt>30.000/mm3 at day
72 (30-360). The overall survival was 80% and 3 /15 relapsed at + 6 months
and could not get a second remission. In PBSCT group survival is
significantly better than the BM group (80%v49.54%)p< 0.0005. Because
our TRM is 0 % for both groups and the only reason of failure is relapse
this may be the result of the additional CTX used for mobilization. Or may
be the result of small number of our patients.