Sequential Intensified Conditioning Regimen Allogeneic Hematopoietic Stem Cell Transplantation in Adult Patients with Intermediate- or High-Risk Acute Myeloid Leukemia in Complete Remission: A Study from the Acute Leukemia Working Party of the European Group for Blood and Marrow Transplantation

Florent Malard, Myriam Labopin, Gernot Stuhler, Jörg Bittenbring, Arnold Ganser, Johanna Tischer, Mauricette Michallet, Nicolaus Kröger, Christoph Schmid, Anne Huynh, Michael Hallek, Bipin N. Savani, Mohamad Mohty, Arnon Nagler

Research output: Contribution to journalArticlepeer-review

Abstract

Post-transplant relapse is the leading cause of treatment failure in acute myeloid leukemia (AML) patients after reduced-intensity conditioning allogeneic hematopoietic stem cell transplantation (allo-HSCT). To improve their outcome, we evaluated the outcome of a sequential intermediate-intensity conditioning regimen combining fludarabine, cytosine arabinoside, amsacrine, cyclophosphamide, and either total body irradiation or busulfan (FLAMSA) in patients with intermediate or high-risk AML in first or second complete remission (CR). A total of 265 patients (median age, 55 years; range, 19 to 76) with AML who underwent allo-HSCT using a FLAMSA regimen were included. At the time of transplant, 216 (81.5%) were in CR1 and 49 (18.5%) in CR2. Cytogenetic was intermediate in 114 (43%) and poor in 42 (15.8%) patients, whereas 109 patients (41.1%) had a secondary AML. With a median follow-up of 46 months (range, 1 to 145), the Kaplan-Meier estimate of overall and leukemia-free survival at 2 years were 56.1% (95% CI, 49.7% to 62.6%) and 52.8% (95% CI, 46.4% to 59.2%), respectively. At 2 years, the cumulative incidences of relapse and nonrelapse mortality were 22.8% (95% CI, 17.6% to 28.4%) and 24.0% (95% CI, 18.8% to 29.5%), respectively. In multivariate analysis, patient age and cytogenetics were the only parameters with a significant impact on overall survival. These data suggest that the FLAMSA sequential intermediate conditioning regimen provides an efficient disease control in intermediate- and high-risk AML patients, including those in CR2 and with secondary AML.

Original languageEnglish
Pages (from-to)278-284
Number of pages7
JournalBiology of Blood and Marrow Transplantation
Volume23
Issue number2
DOIs
StatePublished - 1 Feb 2017
Externally publishedYes

Keywords

  • Acute myeloid leukemia
  • Allogeneic hematopoietic stem cell transplantation
  • Complete remission
  • Intermediate intensity conditioning regimen
  • Sequential conditioning regimen

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