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Similar outcome of allogeneic stem cell transplantation after myeloablative and sequential conditioning regimen in patients with refractory or relapsed acute myeloid leukemia: A study from the Société Francophone de Greffe de Moelle et de Thérapie Cellulaire
Author(s) -
Decroocq Justine,
Itzykson Raphaël,
Vigouroux Stéphane,
Michallet Mauricette,
YakoubAgha Ibrahim,
Huynh Anne,
Beckerich Florence,
Suarez Felipe,
Chevallier Patrice,
NguyenQuoc Stéphanie,
Ledoux MariePierre,
Clement Laurence,
Hicheri Yosr,
Guillerm Gaëlle,
Cornillon Jérôme,
Contentin Nathalie,
Carre Martin,
Maillard Natacha,
Mercier Mélanie,
Mohty Mohamad,
Beguin Yves,
Bourhis JeanHenri,
Charbonnier Amandine,
Dauriac Charles,
Bay JacquesOlivier,
Blaise Didier,
Deconinck Eric,
Jubert Charlotte,
Raus Nicole,
Peffault de Latour Regis,
Dhedin Nathalie
Publication year - 2018
Publication title -
american journal of hematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.456
H-Index - 105
eISSN - 1096-8652
pISSN - 0361-8609
DOI - 10.1002/ajh.25004
Subject(s) - medicine , cumulative incidence , transplantation , hematopoietic stem cell transplantation , regimen , myeloid leukemia , incidence (geometry) , gastroenterology , surgery , refractory (planetary science) , oncology , physics , astrobiology , optics
Patients with acute myeloid leukemia (AML) in relapse or refractory to induction therapy have a dismal prognosis. Allogeneic hematopoietic stem cell transplantation is the only curative option. In these patients, we aimed to compare the results of a myeloablative transplant versus a sequential approach consisting in a cytoreductive chemotherapy followed by a reduced intensity conditioning regimen and prophylactic donor lymphocytes infusions. We retrospectively analyzed 99 patients aged 18‐50 years, transplanted for a refractory (52%) or a relapsed AML not in remission (48%). Fifty‐eight patients received a sequential approach and 41 patients a myeloablative conditioning regimen. Only 6 patients received prophylactic donor lymphocytes infusions. With a median follow‐up of 48 months, 2‐year overall survival was 39%, 95% confidence interval (CI) (24‐53) in the myeloablative group versus 33%, 95% CI (21‐45) in the sequential groups ( P = .39), and 2‐year cumulative incidence of relapse (CIR) was 57% versus 50% respectively ( P = .99). Nonrelapse mortality was not higher in the myeloablative group (17% versus 15%, P = .44). In multivariate analysis, overall survival, CIR and nonrelapse mortality remained similar between the two groups. However, in multivariate analysis, sequential conditioning led to fewer acute grade II‐IV graft versus host disease (GVHD) (HR for sequential approach = 0.37; 95% CI: 0.21‐0.65; P < .001) without a significant impact on chronic GVHD (all grades and extensive). In young patients with refractory or relapsed AML, myeloablative transplant and sequential approach offer similar outcomes except for a lower incidence of acute GvHD after a sequential transplant.