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Sequential chemotherapy followed by reduced-intensity conditioning and allogeneic haematopoietic stem cell transplantation in adult patients with relapse or refractory acute myeloid leukaemia: a survey from the Acute Leukaemia Working Party of EBMT.
Br J Haematol. 2017 Feb; 176(3):431-439.BJ

Abstract

This study analysed the outcome of 267 patients with relapse/refractory acute myeloid leukaemia (AML) who received sequential chemotherapy including fludarabine, cytarabine and amsacrine followed by reduced-intensity conditioning (RIC) and allogeneic haematopoietic stem cell transplantation (HSCT). The transplants in 77 patients were from matched sibling donors (MSDs) and those in 190 patients were from matched unrelated donors. Most patients (94·3%) were given anti-T-cell antibodies. The incidence of acute graft-versus-host disease (GVHD) of grades II-IV was 32·1% and that of chronic GVHD was 30·2%. The 3-year probability of non-relapse mortality (NRM) was 25·9%, that of relapse was 48·5%, that of GVHD-free and relapse-free survival (GRFS) was 17·8% and that of leukaemia-free survival (LFS) was 25·6%. In multivariate analysis, unrelated donor recipients more frequently had acute GVHD of grades II-IV [hazard ratio (HR) = 1·98, P = 0·017] and suffered less relapses (HR = 0·62, P = 0·01) than MSD recipients. Treatment with anti-T-cell antibodies reduced NRM (HR = 0·35, P = 0·01) and improved survival (HR = 0·49, P = 0·01), GRFS (HR = 0·37, P = 0·0004) and LFS (HR = 0·46, P = 0·005). Thus, sequential chemotherapy followed by RIC HSCT and use of anti-T-cell antibodies seems promising in patients with refractory AML.

Authors+Show Affiliations

Division of Therapeutic Immunology, Karolinska Institutet, Stockholm, Sweden.Service d'Hématologie et Thérapie Cellulaire, Hôpital Saint-Antoine, Paris, France. Hopital Saint-Antoine, AP-HP, Paris, France. Universite Pierre & Marie Curie, Paris, France. INSERM UMRs 938, CEREST-TC EBMT, Paris, France.II Medizinische Klinik, Klinikum Augsburg, Augsburg, Germany.Division of Therapeutic Immunology, Karolinska Institutet, Stockholm, Sweden.Service d'Hématologie et Thérapie Cellulaire, Hôpital Saint-Antoine, Paris, France. Hopital Saint-Antoine, AP-HP, Paris, France. Universite Pierre & Marie Curie, Paris, France. INSERM UMRs 938, CEREST-TC EBMT, Paris, France.Med Klinik III, Klinikum Grosshadern, Munich, Germany.Department of Haematology/Oncology, Hannover Medical University, Hannover, Germany.BMT Unit, Hospital Herriot, Lyon, France.Department of Medicine, University of Tübingen, Tübingen, Germany.Department of Haematology, Oncology, and Immunology, Helios-Kliniken Berlin-Buch, Berlin, Germany.Chaim Sheba Medical Centre, Tel-Hashomer, Israel.Service d'Hématologie et Thérapie Cellulaire, Hôpital Saint-Antoine, Paris, France. Hopital Saint-Antoine, AP-HP, Paris, France. Universite Pierre & Marie Curie, Paris, France. INSERM UMRs 938, CEREST-TC EBMT, Paris, France.No affiliation info available

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

27879990

Citation

Ringdén, Olle, et al. "Sequential Chemotherapy Followed By Reduced-intensity Conditioning and Allogeneic Haematopoietic Stem Cell Transplantation in Adult Patients With Relapse or Refractory Acute Myeloid Leukaemia: a Survey From the Acute Leukaemia Working Party of EBMT." British Journal of Haematology, vol. 176, no. 3, 2017, pp. 431-439.
Ringdén O, Labopin M, Schmid C, et al. Sequential chemotherapy followed by reduced-intensity conditioning and allogeneic haematopoietic stem cell transplantation in adult patients with relapse or refractory acute myeloid leukaemia: a survey from the Acute Leukaemia Working Party of EBMT. Br J Haematol. 2017;176(3):431-439.
Ringdén, O., Labopin, M., Schmid, C., Sadeghi, B., Polge, E., Tischer, J., Ganser, A., Michallet, M., Kanz, L., Schwerdtfeger, R., Nagler, A., & Mohty, M. (2017). Sequential chemotherapy followed by reduced-intensity conditioning and allogeneic haematopoietic stem cell transplantation in adult patients with relapse or refractory acute myeloid leukaemia: a survey from the Acute Leukaemia Working Party of EBMT. British Journal of Haematology, 176(3), 431-439. https://doi.org/10.1111/bjh.14428
Ringdén O, et al. Sequential Chemotherapy Followed By Reduced-intensity Conditioning and Allogeneic Haematopoietic Stem Cell Transplantation in Adult Patients With Relapse or Refractory Acute Myeloid Leukaemia: a Survey From the Acute Leukaemia Working Party of EBMT. Br J Haematol. 2017;176(3):431-439. PubMed PMID: 27879990.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Sequential chemotherapy followed by reduced-intensity conditioning and allogeneic haematopoietic stem cell transplantation in adult patients with relapse or refractory acute myeloid leukaemia: a survey from the Acute Leukaemia Working Party of EBMT. AU - Ringdén,Olle, AU - Labopin,Myriam, AU - Schmid,Christoph, AU - Sadeghi,Behnam, AU - Polge,Emmanuelle, AU - Tischer,Johanna, AU - Ganser,Arnold, AU - Michallet,Mauricette, AU - Kanz,Lothar, AU - Schwerdtfeger,Rainer, AU - Nagler,Arnon, AU - Mohty,Mohamad, AU - ,, Y1 - 2016/11/23/ PY - 2016/03/29/received PY - 2016/06/17/accepted PY - 2016/11/24/pubmed PY - 2017/5/20/medline PY - 2016/11/24/entrez KW - acute myeloid leukaemia KW - allogeneic haematopoietic stem cell transplantation KW - reduced intensity conditioning KW - sequential chemotherapy SP - 431 EP - 439 JF - British journal of haematology JO - Br J Haematol VL - 176 IS - 3 N2 - This study analysed the outcome of 267 patients with relapse/refractory acute myeloid leukaemia (AML) who received sequential chemotherapy including fludarabine, cytarabine and amsacrine followed by reduced-intensity conditioning (RIC) and allogeneic haematopoietic stem cell transplantation (HSCT). The transplants in 77 patients were from matched sibling donors (MSDs) and those in 190 patients were from matched unrelated donors. Most patients (94·3%) were given anti-T-cell antibodies. The incidence of acute graft-versus-host disease (GVHD) of grades II-IV was 32·1% and that of chronic GVHD was 30·2%. The 3-year probability of non-relapse mortality (NRM) was 25·9%, that of relapse was 48·5%, that of GVHD-free and relapse-free survival (GRFS) was 17·8% and that of leukaemia-free survival (LFS) was 25·6%. In multivariate analysis, unrelated donor recipients more frequently had acute GVHD of grades II-IV [hazard ratio (HR) = 1·98, P = 0·017] and suffered less relapses (HR = 0·62, P = 0·01) than MSD recipients. Treatment with anti-T-cell antibodies reduced NRM (HR = 0·35, P = 0·01) and improved survival (HR = 0·49, P = 0·01), GRFS (HR = 0·37, P = 0·0004) and LFS (HR = 0·46, P = 0·005). Thus, sequential chemotherapy followed by RIC HSCT and use of anti-T-cell antibodies seems promising in patients with refractory AML. SN - 1365-2141 UR - https://www.unboundmedicine.com/medline/citation/27879990/Sequential_chemotherapy_followed_by_reduced_intensity_conditioning_and_allogeneic_haematopoietic_stem_cell_transplantation_in_adult_patients_with_relapse_or_refractory_acute_myeloid_leukaemia:_a_survey_from_the_Acute_Leukaemia_Working_Party_of_EBMT_ L2 - https://doi.org/10.1111/bjh.14428 DB - PRIME DP - Unbound Medicine ER -