Back to Search
Start Over
Similar outcome of allogeneic stem cell transplantation after myeloablative and sequential conditioning regimen in patients with refractory or relapsed acute myeloid leukemia: A study from the Société Francophone de Greffe de Moelle et de Thérapie Cellulaire.
- Source :
-
American journal of hematology [Am J Hematol] 2018 Mar; Vol. 93 (3), pp. 416-423. Date of Electronic Publication: 2018 Jan 08. - Publication Year :
- 2018
-
Abstract
- Patients with acute myeloid leukemia (AML) in relapse or refractory to induction therapy have a dismal prognosis. Allogeneic hematopoietic stem cell transplantation is the only curative option. In these patients, we aimed to compare the results of a myeloablative transplant versus a sequential approach consisting in a cytoreductive chemotherapy followed by a reduced intensity conditioning regimen and prophylactic donor lymphocytes infusions. We retrospectively analyzed 99 patients aged 18-50 years, transplanted for a refractory (52%) or a relapsed AML not in remission (48%). Fifty-eight patients received a sequential approach and 41 patients a myeloablative conditioning regimen. Only 6 patients received prophylactic donor lymphocytes infusions. With a median follow-up of 48 months, 2-year overall survival was 39%, 95% confidence interval (CI) (24-53) in the myeloablative group versus 33%, 95% CI (21-45) in the sequential groups (P = .39), and 2-year cumulative incidence of relapse (CIR) was 57% versus 50% respectively (P = .99). Nonrelapse mortality was not higher in the myeloablative group (17% versus 15%, P = .44). In multivariate analysis, overall survival, CIR and nonrelapse mortality remained similar between the two groups. However, in multivariate analysis, sequential conditioning led to fewer acute grade II-IV graft versus host disease (GVHD) (HR for sequential approach = 0.37; 95% CI: 0.21-0.65; P < .001) without a significant impact on chronic GVHD (all grades and extensive). In young patients with refractory or relapsed AML, myeloablative transplant and sequential approach offer similar outcomes except for a lower incidence of acute GvHD after a sequential transplant.<br /> (© 2018 Wiley Periodicals, Inc.)
- Subjects :
- Adolescent
Adult
Allografts
Antimetabolites, Antineoplastic therapeutic use
Disease-Free Survival
Female
Follow-Up Studies
Graft vs Host Disease etiology
Humans
Immunosuppressive Agents therapeutic use
Kaplan-Meier Estimate
Leukemia, Myeloid, Acute mortality
Lymphocyte Transfusion
Male
Middle Aged
Myeloablative Agonists administration & dosage
Recurrence
Retrospective Studies
Survival Rate
Treatment Outcome
Whole-Body Irradiation
Young Adult
Hematopoietic Stem Cell Transplantation
Leukemia, Myeloid, Acute therapy
Myeloablative Agonists therapeutic use
Salvage Therapy
Transplantation Conditioning methods
Subjects
Details
- Language :
- English
- ISSN :
- 1096-8652
- Volume :
- 93
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- American journal of hematology
- Publication Type :
- Academic Journal
- Accession number :
- 29226497
- Full Text :
- https://doi.org/10.1002/ajh.25004