Mitoxantrone and Melphalan Conditioning Regimen for Autologous Peripheral Blood Stem Cell Transplantation in Adults with Acute Myelogenous Leukemia.

Abstract

High dose mitoxantrone and melphalan (Mito/Mel) has been reported as an effective and well tolerated conditioning regimen for autologous peripheral blood stem cell transplantation (APBSCT) in patients with lymphoma. We review our experience with Mito/Mel as a conditioning regimen in 18 adults with intermediate or high risk acute myelogenous leukemia (AML) who underwent APBSCT. Median age at time of APBSCT was 51 years (range 19–70). Sixteen patients were transplanted in first complete remission (CR); two in second CR. All patients received mitoxantrone 60mg/m2 IV on day −4 and melphalan 180mg/m2 IV on day −1 followed by infusion of autologous peripheral blood stem cells on day 0. The 100 day survival was 94%. One patient died in CR of suspected pulmonary embolism 3 months post transplant. With a median follow-up of 24 months, 10 patients are alive. The median disease free and overall survival is 40 months and 47 months, respectively. All 18 patients received anthracycline based induction therapy prior to APBSCT. Cardiac toxicity was monitored by echocardiogram. A significant decline in left ventricular function developed in only one patient who had underlying diabetes and hypertension. We conclude that high dose mitoxantrone and melphalan is an easily administered conditioning regimen with a low risk of significant cardiac toxicity despite prior treatment with anthracycline based chemotherapy. This regimen when used for APBSCT in adults with AML results in favorable disease free and overall survival.