- Titel
- Allogeneic Stem Cell Transplantation with Sequential Melphalan-Based Conditioning in AML
- Untertitel
- Residual Morphological Blast Count Determines the Risk of Relapse
- Zitierfähige Url:
- https://nbn-resolving.org/urn:nbn:de:bsz:14-qucosa2-919462
- Quellenangabe
- Cancer management and research
Erscheinungsjahr: 2022
Jahrgang: 14
Seiten: 547-559
E-ISSN: 1179-1322 - Abstract (EN)
- Introduction: Allogeneic hematopoietic cell transplantation (HCT) during chemotherapy-induced aplasia may offer long-term survival in acute myeloid leukemia (AML) with otherwise poor prognosis including ELN adverse risk, relapsed or refractory disease. However, the value of residual morphologic disease prior HCT in this context has not been conclusively settled until yet. Therefore, we aimed to investigate variables predicting outcome in this unique setting of sequential conditioning therapy, with a focus on pretreatment morphologic blast count. In contrast to the most popular FLAMSA-RIC protocol, we used a melphalan-based conditioning regimen during aplasia. Methods: We retrospectively analyzed data from 173 AML patients who underwent a sequential melphalan-based conditioning therapy between 2003 and 2015 at our centre. All patients participated either in the prospective Phase 2 BRIDGE trial (NCT01295307), the Phase 3 AML2003 study (NCT00180102) or were treated according to this protocol and underwent allogeneic HCT after melphalan-based conditioning in treatment-induced aplasia. Results: Median bone marrow blast count prior to conditioning was 10% (range, 0–96%). Four year probabilities of EFS and OS were 34% (95% CI, 28–43%) and 43% (95% CI, 36–52%), respectively. In multivariate analysis, blast count >20% was associated with worse EFS (HR = 1.93; p = 0.009) and OS (HR = 1.80; p = 0.026). This effect was not significant anymore for HCT during 1st line therapy. Conclusion: Allogeneic HCT in aplasia with a melphalan-based conditioning regimen has the potential to cure a subset of adverse risk AML patients, even with persistent morphological disease prior HCT. However, a high pre-transplant blast count still indicates patients with a dismal prognosis, especially in the relapsed patient group, for whom post-transplant strategies should be considered to further optimize post HCT outcome.
- Andere Ausgabe
- Link zum Artikel der zuerst in der Zeitschrift „Cancer management and research” erschienen ist.
DOI: 10.2147/CMAR.S339846 - Freie Schlagwörter (DE)
- akute myeloische Leukämie, ELN-Hochrisiko, AML-Rezidiv/refraktär, frühe allogene Transplantation bei Aplasie, Blastenzahl, Melphalan-basierte Konditionierung, sequenzielle Konditionierung
- Freie Schlagwörter (EN)
- acute myeloid leukemia, ELN high risk, AML relapse/refractory, early allogeneic transplantation in aplasia, blast count, melphalan-based conditioning, sequential conditioning
- Klassifikation (DDC)
- 610
- Verlag
- Dove Medical Press, Albany, Auckland
- Version / Begutachtungsstatus
- publizierte Version / Verlagsversion
- URN Qucosa
- urn:nbn:de:bsz:14-qucosa2-919462
- Veröffentlichungsdatum Qucosa
- 11.06.2024
- Dokumenttyp
- Artikel
- Sprache des Dokumentes
- Englisch
- Lizenz / Rechtehinweis
CC BY 4.0