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Effects of priming with recombinant human granulocyte colony-stimulating factor on conditioning regimen for high-risk acute myeloid leukemia patients undergoing human leukocyte antigen-haploidentical hematopoietic stem cell transplantation: a multicenter randomized controlled study in southwest China.
Biol Blood Marrow Transplant. 2014 Dec; 20(12):1932-9.BB

Abstract

HLA-haploidentical hematopoietic stem cell transplantation (haplo-HSCT) is an effective and immediate treatment for high-risk acute myeloid leukemia (HR-AML) patients lacking matched donors. Relapse remains the leading cause of death for HR-AML patients after haplo-HSCT. Accordingly, the prevention of relapse remains a challenge in the treatment of HR-AML. In a multicenter randomized controlled trial in southwestern China, 178 HR-AML patients received haplo-HSCT with conditioning regimens involving recombinant human granulocyte colony-stimulating factor (rhG-CSF) or non-rhG-CSF. The cumulative incidences of relapse and graft-versus-host disease (GVHD), 2-year leukemia-free survival (LFS), and overall survival (OS) were evaluated. HR-AML patients who underwent the priming conditioning regimen with rhG-CSF had a lower relapse rate than those who were treated with non-rhG-CSF (38.2%; 95% confidence interval [CI], 28.1% to 48.3% versus 60.7%, 95% CI, 50.5% to 70.8%; P < .01). The cumulative incidences of acute GVHD, chronic GVHD, transplantation-related toxicity, and infectious complications appeared to be equivalent. In total, 53 patients in the rhG-CSF-priming group and 31 patients in the non-rhG-CSF-priming group were still alive at the median follow-up time of 42 months (range, 24 to 80 months). The 2-year probabilities of LFS and OS in the rhG-CSF-priming and non-rhG-CSF-priming groups were 55.1% (95% CI, 44.7% to 65.4%) versus 32.6% (95% CI, 22.8% to 42.3%) (P < .01) and 59.6% (95% CI, 49.4% to 69.7%) versus 34.8% (95% CI, 24.9% to 44.7%) (P < .01), respectively. Multivariate analyses indicated that the 2-year probability of LFS of patients who achieved complete remission (CR) before transplantation was better than that of patients who did not achieve CR. The 2-year probability of LFS of patients with no M4/M5/M6 subtype was better than that of patients with the M4/M5/M6 subtype in the G-CSF-priming group (67.4%; 95% CI, 53.8% to 80.9% versus 41.9%; 95% CI, 27.1% to 56.6%; P < .05). This study suggests that the rhG-CSF-priming conditioning regimen is an acceptable choice for HR-AML patients, especially for the patients with no M4/M5/M6 subtype who achieved CR before transplantation.

Authors+Show Affiliations

Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, China.Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, China.Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, China.Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, China.Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, China.Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, China.Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, China.Department of Health Statistics, College of Military Preventive Medicine, Third Military Medical University, Chongqing, China.Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, China.Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, China.Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, China.Department of Hematology, General Hospital of Chengdu Military Region of PLA, Chengdu, China.Department of Hematology, Sichuan Provincial Peoples Hospital, Chengdu, China.Department of Hematology, General Hospital of Kunming Military Region of PLA, Kunming, China.Department of Hematology, Affiliated Hospital of Kunming Medical College, Kunming, China.Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, China.Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, China.Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, China.Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, China.Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, China.Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, China. Electronic address: zhangxxi@sina.com.

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25109850

Citation

Gao, Lei, et al. "Effects of Priming With Recombinant Human Granulocyte Colony-stimulating Factor On Conditioning Regimen for High-risk Acute Myeloid Leukemia Patients Undergoing Human Leukocyte Antigen-haploidentical Hematopoietic Stem Cell Transplantation: a Multicenter Randomized Controlled Study in Southwest China." Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation, vol. 20, no. 12, 2014, pp. 1932-9.
Gao L, Wen Q, Chen X, et al. Effects of priming with recombinant human granulocyte colony-stimulating factor on conditioning regimen for high-risk acute myeloid leukemia patients undergoing human leukocyte antigen-haploidentical hematopoietic stem cell transplantation: a multicenter randomized controlled study in southwest China. Biol Blood Marrow Transplant. 2014;20(12):1932-9.
Gao, L., Wen, Q., Chen, X., Liu, Y., Zhang, C., Gao, L., Kong, P., Zhang, Y., Li, Y., Liu, J., Wang, Q., Su, Y., Wang, C., Wang, S., Zeng, Y., Sun, A., Du, X., Zeng, D., Liu, H., ... Zhang, X. (2014). Effects of priming with recombinant human granulocyte colony-stimulating factor on conditioning regimen for high-risk acute myeloid leukemia patients undergoing human leukocyte antigen-haploidentical hematopoietic stem cell transplantation: a multicenter randomized controlled study in southwest China. Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation, 20(12), 1932-9. https://doi.org/10.1016/j.bbmt.2014.08.001
Gao L, et al. Effects of Priming With Recombinant Human Granulocyte Colony-stimulating Factor On Conditioning Regimen for High-risk Acute Myeloid Leukemia Patients Undergoing Human Leukocyte Antigen-haploidentical Hematopoietic Stem Cell Transplantation: a Multicenter Randomized Controlled Study in Southwest China. Biol Blood Marrow Transplant. 2014;20(12):1932-9. PubMed PMID: 25109850.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effects of priming with recombinant human granulocyte colony-stimulating factor on conditioning regimen for high-risk acute myeloid leukemia patients undergoing human leukocyte antigen-haploidentical hematopoietic stem cell transplantation: a multicenter randomized controlled study in southwest China. AU - Gao,Lei, AU - Wen,Qin, AU - Chen,Xinghua, AU - Liu,Yao, AU - Zhang,Cheng, AU - Gao,Li, AU - Kong,Peiyan, AU - Zhang,Yanqi, AU - Li,Yunlong, AU - Liu,Jia, AU - Wang,Qingyu, AU - Su,Yi, AU - Wang,Chunsen, AU - Wang,Sanbin, AU - Zeng,Yun, AU - Sun,Aihua, AU - Du,Xin, AU - Zeng,Dongfeng, AU - Liu,Hong, AU - Peng,Xiangui, AU - Zhang,Xi, Y1 - 2014/08/08/ PY - 2014/02/19/received PY - 2014/08/03/accepted PY - 2014/8/12/entrez PY - 2014/8/12/pubmed PY - 2015/7/30/medline KW - Acute myeloid leukemia KW - Granulocyte colony–stimulating factor KW - Haploidentical KW - Hematopoietic stem cell transplantation KW - High risk KW - Priming SP - 1932 EP - 9 JF - Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation JO - Biol Blood Marrow Transplant VL - 20 IS - 12 N2 - HLA-haploidentical hematopoietic stem cell transplantation (haplo-HSCT) is an effective and immediate treatment for high-risk acute myeloid leukemia (HR-AML) patients lacking matched donors. Relapse remains the leading cause of death for HR-AML patients after haplo-HSCT. Accordingly, the prevention of relapse remains a challenge in the treatment of HR-AML. In a multicenter randomized controlled trial in southwestern China, 178 HR-AML patients received haplo-HSCT with conditioning regimens involving recombinant human granulocyte colony-stimulating factor (rhG-CSF) or non-rhG-CSF. The cumulative incidences of relapse and graft-versus-host disease (GVHD), 2-year leukemia-free survival (LFS), and overall survival (OS) were evaluated. HR-AML patients who underwent the priming conditioning regimen with rhG-CSF had a lower relapse rate than those who were treated with non-rhG-CSF (38.2%; 95% confidence interval [CI], 28.1% to 48.3% versus 60.7%, 95% CI, 50.5% to 70.8%; P < .01). The cumulative incidences of acute GVHD, chronic GVHD, transplantation-related toxicity, and infectious complications appeared to be equivalent. In total, 53 patients in the rhG-CSF-priming group and 31 patients in the non-rhG-CSF-priming group were still alive at the median follow-up time of 42 months (range, 24 to 80 months). The 2-year probabilities of LFS and OS in the rhG-CSF-priming and non-rhG-CSF-priming groups were 55.1% (95% CI, 44.7% to 65.4%) versus 32.6% (95% CI, 22.8% to 42.3%) (P < .01) and 59.6% (95% CI, 49.4% to 69.7%) versus 34.8% (95% CI, 24.9% to 44.7%) (P < .01), respectively. Multivariate analyses indicated that the 2-year probability of LFS of patients who achieved complete remission (CR) before transplantation was better than that of patients who did not achieve CR. The 2-year probability of LFS of patients with no M4/M5/M6 subtype was better than that of patients with the M4/M5/M6 subtype in the G-CSF-priming group (67.4%; 95% CI, 53.8% to 80.9% versus 41.9%; 95% CI, 27.1% to 56.6%; P < .05). This study suggests that the rhG-CSF-priming conditioning regimen is an acceptable choice for HR-AML patients, especially for the patients with no M4/M5/M6 subtype who achieved CR before transplantation. SN - 1523-6536 UR - https://www.unboundmedicine.com/medline/citation/25109850/Effects_of_priming_with_recombinant_human_granulocyte_colony_stimulating_factor_on_conditioning_regimen_for_high_risk_acute_myeloid_leukemia_patients_undergoing_human_leukocyte_antigen_haploidentical_hematopoietic_stem_cell_transplantation:_a_multicenter_randomized_controlled_study_in_southwest_China_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1083-8791(14)00500-X DB - PRIME DP - Unbound Medicine ER -