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High‐dose melphalan‐based sequential conditioning chemotherapy followed by allogeneic haematopoietic stem cell transplantation in adult patients with relapsed or refractory acute myeloid leukaemia
Author(s) -
Steckel Nina K.,
Groth Christoph,
Mikesch JanHenrik,
Trenschel Rudolf,
Ottinger Hellmut,
Kordelas Lambros,
MuellerTidow Carsten,
Schliemann Christoph,
Reicherts Christian,
Albring Joern C.,
Silling Gerda,
Schmidt Eva,
Berdel Wolfgang E.,
Lenz Georg,
Ditschkowski Markus,
Beelen Dietrich W.,
Stelljes Matthias
Publication year - 2018
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.15137
Subject(s) - medicine , melphalan , transplantation , total body irradiation , hematopoietic stem cell transplantation , salvage therapy , refractory (planetary science) , chemotherapy , surgery , treosulfan , oncology , gastroenterology , busulfan , cyclophosphamide , physics , astrobiology
Summary Considering the unsatisfactory results of salvage therapies for patients with relapsed/refractory acute myeloid leukaemia (R/R‐ AML ), their value before allogeneic haematopoietic stem cell transplantation ( HSCT ) remains questionable. However, direct allogeneic HSCT following established conditioning regimens applied in patients with R/R‐ AML during active disease has been equally disappointing. In this retrospective observational study, high‐dose melphalan, as part of a sequential preparative regimen, followed by a total body irradiation (4 × 2 Gy)‐based or a treosulfan‐based dose‐adapted conditioning therapy for allogeneic HSCT was administered to 292 adult patients (median age 56 years, range 17–74) with primary refractory (144 patients), secondary refractory (97 patients) or relapsed AML (51 patients). Overall survival rates at 3 years were 34%, 29% and 41%, respectively. Risk factors associated with an inferior survival were higher age, transplantation from a human leucocyte antigen‐mismatched donor and high disease burden. Patients transplanted with blast infiltration <20% showed a notable survival rate of 51% at 3 years. In particular, patients with primary refractory AML showed a more favourable outcome when transplanted early during their disease course. Thus, high‐dose melphalan‐based sequential conditioning chemotherapy followed by an allogeneic HSCT is feasible and enables long‐term remission to be achieved in a substantial proportion of patients with active R/R‐ AML .