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Reduced intensity conditioning prior to allogeneic stem cell transplantation for patients with acute myeloblastic leukemia as a first‐line treatment
Author(s) -
Blaise Didier P.,
Michel Boiron Jean,
Faucher Catherine,
Mohty Mohamad,
Bay JacquesOlivier,
Bardoux ValerieJeanne,
Perreau Virginie,
Coso Diane,
Pigneux Arnaud,
Vey Norbert
Publication year - 2005
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.21418
Subject(s) - medicine , cumulative incidence , fludarabine , busulfan , transplantation , acute myeloblastic leukemia , melphalan , surgery , cytarabine , hematopoietic stem cell transplantation , gastroenterology , chemotherapy , leukemia , oncology , cyclophosphamide
Abstract BACKGROUND Thirty‐three patients (median age 52; range 26–60) with acute myeloblastic leukemia (AML) were included in a pilot study of allogeneic stem cell transplantation (Allo‐SCT) following a reduced‐intensity conditioning (RIC). METHODS Patients achieving first complete remission (CR1) were selected for their high‐risk clinical and/or leukemic features. All patients received two courses of consolidation chemotherapy including one high‐dose cytarabine course. Among them, 13 patients in addition received a high‐dose melphalan course followed by autologous SCT. Then, all patients received an RIC Allo‐SCT combining fludarabine, busulfan, and antithymocyte globulin. RESULTS All patients engrafted had cumulative incidences of Gluksberg System Grade 2 acute and chronic graft‐versus‐host‐disease (GVHD) of 24 (9–39%) and 64 (48–80%), respectively. Three patients died from nonrelapse causes (NRD) (cumulative incidence: 9%, 95% confidence interval (CI): 0‐19) and 6 relapsed (cumulative incidence: 18%, 95% CI: 5–31). With a median follow‐up of 18 months (range 7–52) after Allo‐SCT, 26 patients are alive, of whom 24 remained in CR1 for a 2‐year overall survival and leukemia‐free survival (LFS) probabilities of 79 (range 61–90%) and 76 (range 59–87%), respectively. In a ‘landmark’ analysis starting on Day 100, the occurrence of chronic GVHD was associated with a lower relapse rate (0% vs. 44%: P = 0.007) and improved outcome (LFS; 95% vs. 53%, P = 0.007; overall survival, 95% vs. 61%, P = 0.05). CONCLUSIONS We conclude that the sequential combination of intensive chemotherapy and allogeneic immunotherapy might offer relatively low NRD and leukemia relapse rates even in high‐risk patients. Cancer 2005. © 2005 American Cancer Society.