In the previous study by the Polish Adult Leukemia Group (PALG 1999 Study) we demonstrated that addition of cladribine to standard daunorubicine + cytarabine (DA-7) induction potentiates antileukemic activity of the regimen in acute myeloid leukemia (AML). However, there is a concern that the treatment with purine analogues may affect a successful collection of hematopoietic cells for transplantation (autoHCT).

The goal of this study was to compare the efficacy of peripheral blood and bone marrow hematopoietic CD34+ cell harvest in patients who both in induction and consolidation were treated with or without purine analogues and who were intended for autoHCT.

Sixty-seven AML patients, aged 41 (17–58) years, were included in this study; 33 patients received cladribine-containing regimen (DAC-7), one patient - fludarabine-containing regimen (DAF-7), 33 patients received standard treatment (DA-7, HAM, HD cytarabine). In the DAC-7 treated patients cladribine was also given as a adjunct to second HD cytarabine consolidation. AutoHCT using bone marrow (autoBMT) or peripheral blood (autoBCT) as a source of hematopoietic cells was performed in first complete remission after completion of consolidation therapy. An additional course of AraC 2x2g/m2 on days 1, 3, 5 + G-CSF 10 mg/kg since day 7 was used as mobilization in case of autoBCT.

The number of collected CD34+cells/kg was similar for patients pre-traeted with purine analogues and those not receiving purine analogues: 2.55 (0,79-9,25) x106/kg vs 2.5 (1,41–23,5) x106/kg (p=NS) for peripheral blood and 1.62 (0,32–3,01) x106/kg vs 1.55 (0,5–2,45) x106/kg (p=NS) for bone marrow, respectively. In 90% and 95% of patients for both subgroups sufficient number of hematopoietic cells for transplantation could not be collected (p=NS). The proportion of unsuccessful bone marrow harvest was significantly lower for patients pre-treated purine analogues with purine analogues compared to those not receiving purine analogues (90% vs 56%, p=0,04), wheras not difference was found with respect to peripheral blood cell collection (95% vs 62%, p=NS). All patients who received autoHCT engrafted. The time to neutrophil and platelet recovery was similar for both study subgroups.

We conclude that treatment with purine analogues in course of induction/consolidation therapy does not impair the hematopoietic cell harvest and does not decrease a chance to perform autoBCT or autoBMT in AML patients.

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