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The management of pregnant women with acute promyelocytic leukemia (APL) is a challenge with limited evidence-based information available. We are reporting a series of 14 consecutive pregnant women with APL who were registered in the PETHEMA Data Centre between 1996 and 2012. APL was diagnosed during early pregnancy in five women, late pregnancy in seven, and two additional patients after delivery in an extremely poor clinical condition (pulmonary and cerebral hemorrhage). Eleven of the 12 patients eligible for induction therapy with all-trans retinoic acid and idarubicin achieved complete remission (CR 92 %) and are still in the first CR. All early pregnancies ended in abortion (four induced and one spontaneous), with four of them achieving CR. Eight of nine women in late pregnancy delivered a healthy infant (six cesarean section and two vaginal delivery). All eight babies developed normally. Our results confirm a high cure rate for pregnant women with APL who received all-trans retinoic acid and idarubicin for induction therapy, and an excellent outcome for babies when the disease is diagnosed during late pregnancy. [ABSTRACT FROM AUTHOR]

Previous studies have shown that clofarabine plus low-dose cytarabine (LDAC) could induce roughly 60 % of complete remissions (CR) with acceptable toxicity and induction mortality in elderly acute myeloid leukemia (AML) patients not suitable for intensive chemotherapy. The Programa Español de Tratamientos en Hematología group conducted a trial for patients diagnosed with untreated AML aged 60 years and older, using the combination of clofarabine (20 mg/m × 5 days) plus low-dose cytarabine (20 mg/m × 14 days). The protocol was flexible regarding the use of antifungal and antibacterial prophylaxis, and outpatient induction therapy was allowed. Although the planned recruitment goal was 75 patients, only 11 patients were enrolled (median age, 74 years) after observing high toxicity and unacceptable mortality (46 and 73 % at 4 and 8 weeks, respectively). The response assessment showed three CR (27 %), three resistant diseases (27 %), and five induction deaths (46 %). Induction was administered in an outpatient modality in five patients, while antifungal and antibacterial prophylaxis was not given in seven and five patients, respectively. In our context, induction therapy with the combination of clofarabine (20 mg/m) plus LDAC was associated with high toxicity and unacceptable mortality in elderly AML patients, leading to the early interruption of the trial. Tight patients' clinical monitoring, follow-up, and intensive supportive care seem crucial to achieve at least acceptable clinical outcomes in elderly AML patients receiving clofarabine plus LDAC. This trial is registered at as no. NCT01193400. [ABSTRACT FROM AUTHOR]

Introduction: This study analyses the factors affecting mobilisation and engraftment in autologous peripheral blood progenitor cell transplantation according to the number of CD34[sup +] re-infused. Materials and methods: A total of 190 patients underwent mobilisation with G-CSF alone (n = 113) or in combination with chemotherapy (n = 77). A total of 116 patients (61%) were autografted with <2 × 10[sup 6] CD34[sup +] cells/kg and 74 patients were transplanted with >2 × 10[sup 6] CD34[sup +] cells/kg. Rates of granulocyte and platelet recovery were estimated using the productlimit method of Kaplan-Meier and compared using a log-rank test. The Cox regression model was used for the multivariate analysis of factors influencing engraftment. Differences between cohorts were evaluated by one-way ANOVA or Mann-Whitney tests, and multivariate analysis was performed using a stepwise lineal regression. Results: Neutrophil and platelet engraftment was significantly longer with < 2 × 10[sup 6]/CD34[sup +]/ kg (12 vs 10 days, P = 0.014 and 16 vs 13 days, P = 0.0001 respectively). Platelet recovery was affected by exposure to alkylating agents (P = 0.04), refractory disease (P = 0.02) and AML (P = 0.0001), but only the last two variables remained significant in Cox regression (P < 0.01). Granulocyte engraftment was longer in CML (univariate, P = 0.04) and in refractory disease (multivariate, P = 0.02). In patients re-infused with >2 × 10[sup 6]/CD34[sup +]/kg, the Cox model did not identify prognostic factors for haematopoietic recovery. Conclusion: Although mobilisation schedules and disease status influenced not only the yield of progenitor cells, but also the engraftment kinetics, the number of CD34[sup +] re-infused was the main predictor of haematopoietic recovery. While engraftment succeeded in most of the cases, the re-infusion of >2 × 10[sup 6]/CD34[sup +]/kg resulted in significantly shorter recovery times. [ABSTRACT FROM AUTHOR]