Addition of Cladribine to Induction/Consolidation Regimen Does Not Impair Peripheral Blood Stem Cell Mobilization and Bone Marrow Harvest for Autotransplantation in Acute Myeloid Leukemia Patients

The previous study by the Polish Adult Leukemia Group has demonstrated that addition of cladribine to standard DNR+AraC induction potentiates the antileukemic activity. The goal of this study was to compare the efficacy of bone marrow or peripheral blood hematopoietic cell collection in patients who obtained remission after daunorubicine plus cytarabine induction with cladribine (DAC-7) or without addition of cladribine (DA-7) in preparation for autotransplantation. Sixty-six patients aged 41 years (range, 17–58 years) were included in this study: 33 cases in the DAC-7 and 33 in the DA-7 arm. Hematopoietic cells were collected from the bone marrow (ABMT, n = 29) or from the peripheral blood (ABCT, n = 37) using cytopheresis after administration of AraC (2 × 2 g/m 2) on days 1, 3, 5 and subsequent G-CSF (10 μg/kg) from day 7 as mobilization therapy. The numbers of harvested CD34 + cells were similar in the DAC-7 and DA-7 pretreated patients both after harvesting from peripheral blood (2.55 × 10 6/kg vs 2.5 × 10 6/kg) and from bone marrow (1.62 × 10 6/kg vs 1.55 × 10 6/kg), respectively. The proportion of patients with sufficient material for autologous bone marrow transplantation was higher in the DAC-7 compared with the DA-7 arm. All patients engrafted; hematopoietic recovery was similar in both subgroups. Addition of cladribine to a standard DA induction does not impair the harvesting of hematopoietic cells and their engraftment after autotransplantation.