autologous blood and marrow transplantation - Blog Science ...

48 Chapter 1: AML
Several centers have explored the use of IL-2 either as part of a marrow purging
approach with in vitro incubation of the graft with IL-2, concomitant with administration
of IL-2 in the early posttransplant phase, or as consolidation therapy
following hematologic recovery. 1213
Robinson et al. reported on 22 patients with
acute leukemia in relapse or beyond first remission who underwent autologous
BMT or peripheral blood stem cell transplant using cells that were harvested during
first complete remission. 14
IL-2 was given by continuous intravenous infusion after
hematologic recovery at doses ranging from 9 to 12 million IU/m 2
/d for 4-5 days
followed 1 week later by a 10-day infusion of 1.6 million IU/m 2
/d. Among 17
patients with AML, four remained in continuous remission from 12 to 25 months
after therapy and four of five ALL patients were also in remission 15-25 months
after therapy. This regimen is currently undergoing evaluation in a randomized
study at the Southwest Oncology Group in which patients with lymphoma
undergoing a peripheral blood stem cell transplant are randomized to receive a
single course of IL-2 vs. no therapy.
Based on the laboratory studies indicating induction of effector cells that have
the capacity for lysing autologous tumor cells and the clinical trials indicating a
potential therapeutic effect in patients undergoing autologous transplant for
relapsed disease, we have explored the feasibility of administering posttransplant
IL-2 in patients undergoing autologous transplant following high dose Ara-C
consolidation and mobilization of stem cells and who were then treated with a
radiation-based transplant regimen. The goals of this study were to determine the
feasibility, toxicity, and therapeutic effect of a treatment program that began with
consolidation therapy of AML in first remission.
MATERIALS AND METHODS
Patient population
Between August 1994 and April 1998, 54 patients with AML in first remission
were entered onto the study. The median age of this adult population was 46
(21-60). Cytogenetic analysis of the leukemia at diagnosis included favorable
T8;21, inversion 16=13 (24%), intermediate (normal) = 23 (43%), unfavorable 7
(13%), and indeterminate and unknown 11 (20%). The median time from
achievement of complete remission to entry on study was 27 days (7-327).
Treatment program
Patients with AML in first complete remission were treated with consolidation
therapy using a regimen of high-dose Ara-C with or without idarubicin. Ara-C was
given at 3 g/m 2
over 3 hours for eight doses, and idarubicin was given at 12 mg/m 2