Fludarabine-treosulfan compared to thiotepa-busulfan-fludarabine or FLAMSA as conditioning regimen for patients with primary refractory or relapsed acute myeloid leukemia: a study from the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation (EBMT)
Abstract Background Limited data is available to guide the choice of the conditioning regimen for patients with acute myeloid leukemia (AML) undergoing transplant with persistent disease. Methods We retrospectively compared outcome of fludarabine-treosulfan (FT), thiotepa-busulfan-fludarabine (TBF),...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2019-04-01
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| Series: | Journal of Hematology & Oncology |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13045-019-0727-4 |
| _version_ | 1818303878791168000 |
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| author | Francesco Saraceni Myriam Labopin Arne Brecht Nicolaus Kröger Matthias Eder Johanna Tischer Hélène Labussière-Wallet Hermann Einsele Dietrich Beelen Donald Bunjes Dietger Niederwieser Tilmann Bochtler Bipin N. Savani Mohamad Mohty Arnon Nagler |
| author_facet | Francesco Saraceni Myriam Labopin Arne Brecht Nicolaus Kröger Matthias Eder Johanna Tischer Hélène Labussière-Wallet Hermann Einsele Dietrich Beelen Donald Bunjes Dietger Niederwieser Tilmann Bochtler Bipin N. Savani Mohamad Mohty Arnon Nagler |
| author_sort | Francesco Saraceni |
| collection | DOAJ |
| description | Abstract Background Limited data is available to guide the choice of the conditioning regimen for patients with acute myeloid leukemia (AML) undergoing transplant with persistent disease. Methods We retrospectively compared outcome of fludarabine-treosulfan (FT), thiotepa-busulfan-fludarabine (TBF), and sequential fludarabine, intermediate dose Ara-C, amsacrine, total body irradiation/busulfan, cyclophosphamide (FLAMSA) conditioning in patients with refractory or relapsed AML. Results Complete remission rates at day 100 were 92%, 80%, and 88% for FT, TBF, and FLAMSA, respectively (p = 0.13). Non-relapse mortality, incidence of relapse, acute (a) and chronic (c) graft-versus-host disease (GVHD) rates did not differ between the three groups. Overall survival at 2 years was 37% for FT, 24% for TBF, and 34% for FLAMSA (p = 0.10). Independent prognostic factors for survival were Karnofsky performance score and patient CMV serology (p = 0.01; p = 0.02), while survival was not affected by age at transplant. The use of anti-thymocyte globulin (ATG) was associated with reduced risk of grade III–IV aGVHD (p = 0.02) and cGVHD (p = 0.006), with no influence on relapse. Conclusions In conclusion, FT, TBF, and FLAMSA regimens provided similar outcome in patients undergoing transplant with active AML. Survival was determined by patient characteristics as Karnofsky performance score and CMV serology, however was not affected by age at transplant. ATG appears able to reduce the incidence of acute and chronic GVHD without influencing relapse risk. |
| first_indexed | 2024-12-13T06:01:48Z |
| format | Article |
| id | doaj.art-1953bf4f9ad946aaad8280d944ff90cf |
| institution | Directory Open Access Journal |
| issn | 1756-8722 |
| language | English |
| last_indexed | 2024-12-13T06:01:48Z |
| publishDate | 2019-04-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Hematology & Oncology |
| spelling | doaj.art-1953bf4f9ad946aaad8280d944ff90cf2022-12-21T23:57:18ZengBMCJournal of Hematology & Oncology1756-87222019-04-0112111010.1186/s13045-019-0727-4Fludarabine-treosulfan compared to thiotepa-busulfan-fludarabine or FLAMSA as conditioning regimen for patients with primary refractory or relapsed acute myeloid leukemia: a study from the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation (EBMT)Francesco Saraceni0Myriam Labopin1Arne Brecht2Nicolaus Kröger3Matthias Eder4Johanna Tischer5Hélène Labussière-Wallet6Hermann Einsele7Dietrich Beelen8Donald Bunjes9Dietger Niederwieser10Tilmann Bochtler11Bipin N. Savani12Mohamad Mohty13Arnon Nagler14Department of Internal Medicine and Hematology, AV3, ASUR MarcheEBMT Paris study office- CEREST-TC, Paris, France, Department of Haematology, Saint Antoine HospitalDeutsche Klinik fuer Diagnostik, KMT ZentrumUniversity Hospital Eppendorf, Bone Marrow Transplantation CentreDepartment of Haematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical SchoolKlinikum Grosshadern Med. Klinik IIICentre Hospitalier Lyon Sud, Pavillon Marcel Bérard -Bat 1G, Service HematologieUniversitaetsklinikum Wuerzburg, Med. Klinik und Poliklinik IIUniversity Hospital, Dept. of Bone Marrow TransplantationKlinik fuer Innere Medzin III, Universitätsklinikum UlmDivision of Haematology & Oncology, University Hospital LeipzigUniversity of Heidelberg, Medizinische Klinik u. Poliklinik VVanderbilt University Medical CenterDepartment of Haematology, Saint-Antoine HospitalEBMT Paris study office- CEREST-TC, Paris, France, Department of Haematology, Saint Antoine HospitalAbstract Background Limited data is available to guide the choice of the conditioning regimen for patients with acute myeloid leukemia (AML) undergoing transplant with persistent disease. Methods We retrospectively compared outcome of fludarabine-treosulfan (FT), thiotepa-busulfan-fludarabine (TBF), and sequential fludarabine, intermediate dose Ara-C, amsacrine, total body irradiation/busulfan, cyclophosphamide (FLAMSA) conditioning in patients with refractory or relapsed AML. Results Complete remission rates at day 100 were 92%, 80%, and 88% for FT, TBF, and FLAMSA, respectively (p = 0.13). Non-relapse mortality, incidence of relapse, acute (a) and chronic (c) graft-versus-host disease (GVHD) rates did not differ between the three groups. Overall survival at 2 years was 37% for FT, 24% for TBF, and 34% for FLAMSA (p = 0.10). Independent prognostic factors for survival were Karnofsky performance score and patient CMV serology (p = 0.01; p = 0.02), while survival was not affected by age at transplant. The use of anti-thymocyte globulin (ATG) was associated with reduced risk of grade III–IV aGVHD (p = 0.02) and cGVHD (p = 0.006), with no influence on relapse. Conclusions In conclusion, FT, TBF, and FLAMSA regimens provided similar outcome in patients undergoing transplant with active AML. Survival was determined by patient characteristics as Karnofsky performance score and CMV serology, however was not affected by age at transplant. ATG appears able to reduce the incidence of acute and chronic GVHD without influencing relapse risk.http://link.springer.com/article/10.1186/s13045-019-0727-4Acute myeloid leukemia (AML)Active diseaseAllogeneic transplantationSibling donor (MSD)Unrelated donor (UD)Conditioning regimen |
| spellingShingle | Francesco Saraceni Myriam Labopin Arne Brecht Nicolaus Kröger Matthias Eder Johanna Tischer Hélène Labussière-Wallet Hermann Einsele Dietrich Beelen Donald Bunjes Dietger Niederwieser Tilmann Bochtler Bipin N. Savani Mohamad Mohty Arnon Nagler Fludarabine-treosulfan compared to thiotepa-busulfan-fludarabine or FLAMSA as conditioning regimen for patients with primary refractory or relapsed acute myeloid leukemia: a study from the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation (EBMT) Journal of Hematology & Oncology Acute myeloid leukemia (AML) Active disease Allogeneic transplantation Sibling donor (MSD) Unrelated donor (UD) Conditioning regimen |
| title | Fludarabine-treosulfan compared to thiotepa-busulfan-fludarabine or FLAMSA as conditioning regimen for patients with primary refractory or relapsed acute myeloid leukemia: a study from the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation (EBMT) |
| title_full | Fludarabine-treosulfan compared to thiotepa-busulfan-fludarabine or FLAMSA as conditioning regimen for patients with primary refractory or relapsed acute myeloid leukemia: a study from the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation (EBMT) |
| title_fullStr | Fludarabine-treosulfan compared to thiotepa-busulfan-fludarabine or FLAMSA as conditioning regimen for patients with primary refractory or relapsed acute myeloid leukemia: a study from the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation (EBMT) |
| title_full_unstemmed | Fludarabine-treosulfan compared to thiotepa-busulfan-fludarabine or FLAMSA as conditioning regimen for patients with primary refractory or relapsed acute myeloid leukemia: a study from the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation (EBMT) |
| title_short | Fludarabine-treosulfan compared to thiotepa-busulfan-fludarabine or FLAMSA as conditioning regimen for patients with primary refractory or relapsed acute myeloid leukemia: a study from the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation (EBMT) |
| title_sort | fludarabine treosulfan compared to thiotepa busulfan fludarabine or flamsa as conditioning regimen for patients with primary refractory or relapsed acute myeloid leukemia a study from the acute leukemia working party of the european society for blood and marrow transplantation ebmt |
| topic | Acute myeloid leukemia (AML) Active disease Allogeneic transplantation Sibling donor (MSD) Unrelated donor (UD) Conditioning regimen |
| url | http://link.springer.com/article/10.1186/s13045-019-0727-4 |
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