Tags

Type your tag names separated by a space and hit enter

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).
J Hematol Oncol. 2019 04 25; 12(1):44.JH

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.

Authors+Show Affiliations

Department of Internal Medicine and Hematology, AV3, ASUR Marche, Macerata, Italy. francesco.saraceni@libero.it. Acute Leukemia Working Party - European Society for Blood and Marrow Transplantation, Paris, France. francesco.saraceni@libero.it.EBMT Paris study office- CEREST-TC, Paris, France, Department of Haematology, Saint Antoine Hospital, Paris, France.Deutsche Klinik fuer Diagnostik, KMT Zentrum, Wiesbaden, Germany.University Hospital Eppendorf, Bone Marrow Transplantation Centre, Hamburg, Germany.Department of Haematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany.Klinikum Grosshadern Med. Klinik III, Munich, Germany.Centre Hospitalier Lyon Sud, Pavillon Marcel Bérard -Bat 1G, Service Hematologie, Lyon, France.Universitaetsklinikum Wuerzburg, Med. Klinik und Poliklinik II, Wuerzburg, Germany.University Hospital, Dept. of Bone Marrow Transplantation, Essen, Germany.Klinik fuer Innere Medzin III, Universitätsklinikum Ulm, Ulm, Germany.Division of Haematology & Oncology, University Hospital Leipzig, Leipzig, Germany.University of Heidelberg, Medizinische Klinik u. Poliklinik V, Heidelberg, Germany.Vanderbilt University Medical Center, Nashville, TN, USA.Department of Haematology, Saint-Antoine Hospital, Paris, France.EBMT Paris study office- CEREST-TC, Paris, France, Department of Haematology, Saint Antoine Hospital, Paris, France. Department of Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel-Hashomer, Israel.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31023346

Citation

Saraceni, Francesco, et al. "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, vol. 12, no. 1, 2019, p. 44.
Saraceni F, Labopin M, Brecht A, et al. 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). J Hematol Oncol. 2019;12(1):44.
Saraceni, F., Labopin, M., Brecht, A., Kröger, N., Eder, M., Tischer, J., Labussière-Wallet, H., Einsele, H., Beelen, D., Bunjes, D., Niederwieser, D., Bochtler, T., Savani, B. N., Mohty, M., & Nagler, A. (2019). 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, 12(1), 44. https://doi.org/10.1186/s13045-019-0727-4
Saraceni F, et al. 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). J Hematol Oncol. 2019 04 25;12(1):44. PubMed PMID: 31023346.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - 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). AU - Saraceni,Francesco, AU - Labopin,Myriam, AU - Brecht,Arne, AU - Kröger,Nicolaus, AU - Eder,Matthias, AU - Tischer,Johanna, AU - Labussière-Wallet,Hélène, AU - Einsele,Hermann, AU - Beelen,Dietrich, AU - Bunjes,Donald, AU - Niederwieser,Dietger, AU - Bochtler,Tilmann, AU - Savani,Bipin N, AU - Mohty,Mohamad, AU - Nagler,Arnon, Y1 - 2019/04/25/ PY - 2019/01/05/received PY - 2019/03/31/accepted PY - 2019/4/27/entrez PY - 2019/4/27/pubmed PY - 2020/5/16/medline KW - Active disease KW - Acute myeloid leukemia (AML) KW - Allogeneic transplantation KW - Conditioning regimen KW - Fludarabine, intermediate dose Ara-C, amsacrine, total body irradiation/busulfan, cyclophosphamide (FLAMSA) KW - Fludarabine-treosulfan (FT) KW - Sibling donor (MSD) KW - Thiotepa-busulfan-fludarabine (TBF) KW - Unrelated donor (UD) SP - 44 EP - 44 JF - Journal of hematology & oncology JO - J Hematol Oncol VL - 12 IS - 1 N2 - 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. SN - 1756-8722 UR - https://www.unboundmedicine.com/medline/citation/31023346/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__ L2 - https://jhoonline.biomedcentral.com/articles/10.1186/s13045-019-0727-4 DB - PRIME DP - Unbound Medicine ER -