Feasibility of High Dose Melphalan (140 Mg/m2) and Peripheral Blood Stem Cell Support As Consolidation for Patients over 60 Years with Acute Myeloid Leukemia in First Complete Remission

The optimal post remission treatment of acute myeloid leukemia(AML) in patients over 60years remains controversial and is regularly disappointing This is explained by a higher incidence of adverse prognostic factors but also host related factors which limit high dose chemotherapy delivery We report here the feasibility of peripheral blood stem cell( PBSC) collection and tolerance of Melphalan 140 mg/m2 and PBSC support in AML first complete remission (CR1) patients. Thirty one patients received classical Daunorubicin(DNR)/Arac induction:66 years(61–80) 17 de novo AML, 14 secondary AML. Complete remission, toxic death and resistance rate were 58%, 16%, and 26% respectively. Twelve/18 CR1(66%) underwent apheresis after 2 consolidations( DNR/Arac then Cyclophosphamide(CY)/VP16) which collected a median of 7,7(3–23) CD34/kg with a median of 2(2–5) cytapheresis These 12 patients received Melphalan followed by PBPC infusion at Day 0 and GCSF at Day 6 with excellent tolerance. Median neutrophil reconstitution> 1.109 /l and platelet> 50.109/l were observed at Day 11(10–14) and Day 15 respectively,median Day of hospital discharge was Day 14(0–24). The median 1 year overall survival (OS), disease free survival(DFS) is 42%(26–60) and 47%(26–69) respectively. This preliminary report suggest that high dose Melphalan can be safely incorporated in the therapeutic strategy of elderly AML patients. Given the 50% relapses already observed, a second intensification also supported by PBSC should be considered.