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Comparable Outcome of Allogeneic versus Autologous Hematopoietic Peripheral Blood Stem Cell Transplantation in Acute Myeloid Leukemia Patients with Normal Karyotype and FLT3-ITD Negative

Hossam K Mahmoud, Alaa M ElHaddad, Omar A Fahmy, Mohamed A Samra, Raafat M Abdelfattah, Yasser H ElNahass, Hossam A ElAshtoukh, Gamal M Fathy and Fatma M ElRefaey

Introduction: Optimal post-remission treatment for acute myeloid leukemia patients with normal karyotype (AMLNK) in first complete remission (CR1) who lacks an HLA identical donor is still not well-defined.

Aim of the Work: To compare the outcome of allogeneic versus autologous peripheral blood stem cell transplantation (PBSCT) in adult AML patients regarding toxicities of transplant procedure, transplant-related mortality (TRM), disease free survival (DFS) and overall survival (OS).

Patients and Methods: 43 AML patients were included; 34 patients (with a median age 28 years) received myeloablative allogeneic PBSCT from a matched sibling donor while 9 patients (with a median age 36 years) received PBSC autograft. All patients had a normal karyotype (NK), FMS-like tyrosine kinase 3 internal tandem duplication (FLT3 ITD) negative and were in CR1.

Results: After a median follow up of 21.5 months (0.3- 46.5), the cumulative 2-year OS and DFS in the allogeneic group were 73.5% and 70.6% respectively, compared to 74.1% and 64.8%, respectively in the autologous group (p=0.690 and 0.768). Increasing number of consolidation cycles (>3) and lower CD34 stem cell dose were associated with lower relapse rates and higher DFS in the autologous group.

Conclusion: Preliminary data show a comparable outcome of autologous compared to allogeneic PBSCT in patients with AML-NK and FLT3 ITD negative in CR1. In absence of matched sibling donor, autologous PBSCT may provide an acceptable post remission therapy for patients with low risk molecular profile.