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Sequential chemotherapy followed by reduced‐intensity conditioning and allogeneic haematopoietic stem cell transplantation in adult patients with relapse or refractory acute myeloid leukaemia: a survey from the Acute Leukaemia Working Party of EBMT
Author(s) -
Ringdén Olle,
Labopin Myriam,
Schmid Christoph,
Sadeghi Behnam,
Polge Emmanuelle,
Tischer Johanna,
Ganser Arnold,
Michallet Mauricette,
Kanz Lothar,
Schwerdtfeger Rainer,
Nagler Ar,
Mohty Mohamad
Publication year - 2017
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/bjh.14428
Subject(s) - medicine , fludarabine , chemotherapy , transplantation , gastroenterology , hazard ratio , cytarabine , hematopoietic stem cell transplantation , refractory (planetary science) , immunology , oncology , cyclophosphamide , biology , confidence interval , astrobiology
Summary This study analysed the outcome of 267 patients with relapse/refractory acute myeloid leukaemia ( AML ) who received sequential chemotherapy including fludarabine, cytarabine and amsacrine followed by reduced‐intensity conditioning ( RIC ) and allogeneic haematopoietic stem cell transplantation ( HSCT ). The transplants in 77 patients were from matched sibling donors ( MSD s) and those in 190 patients were from matched unrelated donors. Most patients (94·3%) were given anti‐T‐cell antibodies. The incidence of acute graft‐ versus ‐host disease ( GVHD ) of grades II ‒ IV was 32·1% and that of chronic GVHD was 30·2%. The 3‐year probability of non‐relapse mortality ( NRM ) was 25·9%, that of relapse was 48·5%, that of GVHD ‐free and relapse‐free survival ( GRFS ) was 17·8% and that of leukaemia‐free survival ( LFS ) was 25·6%. In multivariate analysis, unrelated donor recipients more frequently had acute GVHD of grades II ‒ IV [hazard ratio ( HR ) = 1·98, P = 0·017] and suffered less relapses ( HR = 0·62, P = 0·01) than MSD recipients. Treatment with anti‐T‐cell antibodies reduced NRM ( HR = 0·35, P = 0·01) and improved survival ( HR = 0·49, P = 0·01), GRFS ( HR = 0·37, P = 0·0004) and LFS ( HR = 0·46, P = 0·005). Thus, sequential chemotherapy followed by RIC HSCT and use of anti‐T‐cell antibodies seems promising in patients with refractory AML .