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- Title
Early allo-SCT for AML with a complex aberrant karyotype-results from a prospective pilot study.
- Authors
Schmid, C; Schleuning, M; Tischer, J; Holler, E; Haude, K-H; Braess, J; Haferlach, C; Baurmann, H; Oruzio, D; Hahn, J; Spiekermann, K; Schlimok, G; Schwerdtfeger, R; Buechner, T; Hiddemann, W; Kolb, H-J
- Abstract
In AML, a complex aberrant karyotype is associated with poor response to chemotherapy and dismal prognosis. We prospectively studied the concept of allogeneic haematopoietic SCT (HSCT), performed early and regardless of response to induction treatment in patients with complex karyotype AML (CK-AML). The preparative regimen consisted of fludarabine, Ara-C and amsacrine (FLAMSA) chemotherapy, followed by reduced intensity conditioning (RIC) 3 days later. In vivo T-cell depletion by anti-thymocyte globulin was used to protect from early GvHD, and prophylactic donor lymphocyte transfusion was given from day+120 to augment the GvL effect, once tolerance was established. Eighteen consecutive patients with CK-AML (median age: 53 years) received HSCT from related (n=7) or unrelated (n=11) donors. Before FLAMSA-RIC, nine patients each had received one and two induction courses. Stage at start of FLAMSA-RIC was CR/CRi (n=8) or persistent disease (n=10). Following HSCT, 16 patients achieved CR. After a follow-up of 51 months, 11 patients are alive in CR, whereas seven have died in remission (n=3), or from leukaemia (n=4). Cumulative incidence of relapse, non-relapse mortality, acute GvHDII and chronic GvHD were 0.222±0.098, 0.235±0.104, 0.367±0.120 and 0.481±0.123, respectively. Four-year survival from HSCT is 61%. Early HSCT following FLAMSA-RIC may improve the outcome of this unfavourable AML subgroup.
- Subjects
ACUTE myeloid leukemia; HEMATOPOIETIC stem cell transplantation; KARYOTYPES; PILOT projects; CANCER chemotherapy; LEUKEMIA; LEUKEMIA diagnosis; FLUDARABINE
- Publication
Bone Marrow Transplantation, 2012, Vol 47, Issue 1, p46
- ISSN
0268-3369
- Publication type
Article
- DOI
10.1038/bmt.2011.15