Impact on Outcome of Minimal Residual Disease after Hematopoietic Stem Cell Transplantation with Fludarabine, Amsacrine, and Cytosine Arabinoside-Busulfan Conditioning: A Retrospective Monocentric Study.

Autor: Meur GL; Department of Hematology, Lyon-Sud Hospital, Hospices Civils de Lyon, Pierre Bénite, France; Université Claude Bernard, Lyon, France. Electronic address: gregoire.le-meur@chu-lyon.fr., Plesa A; Laboratory of Cytology and Immunology, Lyon-Sud Hospital, Hospices Civils de Lyon, Pierre Bénite, France., Larcher MV; Department of Hematology, Lyon-Sud Hospital, Hospices Civils de Lyon, Pierre Bénite, France., Fossard G; Department of Hematology, Lyon-Sud Hospital, Hospices Civils de Lyon, Pierre Bénite, France., Barraco F; Department of Hematology, Lyon-Sud Hospital, Hospices Civils de Lyon, Pierre Bénite, France., Loron S; Department of Hematology, Lyon-Sud Hospital, Hospices Civils de Lyon, Pierre Bénite, France., Balsat M; Department of Hematology, Lyon-Sud Hospital, Hospices Civils de Lyon, Pierre Bénite, France., Ducastelle-Leprêtre S; Department of Hematology, Lyon-Sud Hospital, Hospices Civils de Lyon, Pierre Bénite, France., Gilis L; Department of Hematology, Lyon-Sud Hospital, Hospices Civils de Lyon, Pierre Bénite, France., Thomas X; Department of Hematology, Lyon-Sud Hospital, Hospices Civils de Lyon, Pierre Bénite, France., Ghesquières H; Department of Hematology, Lyon-Sud Hospital, Hospices Civils de Lyon, Pierre Bénite, France; Université Claude Bernard, Lyon, France., Tigaud I; Laboratory of Cytogenetics, Lyon-Sud Hospital, Hospices Civils de Lyon, Pierre Bénite, France., Hayette S; Laboratory of Molecular Biology, Lyon-Sud Hospital, Hospices Civils de Lyon, Pierre Bénite, France., Huet S; Laboratory of Molecular Biology, Lyon-Sud Hospital, Hospices Civils de Lyon, Pierre Bénite, France., Sujobert P; Laboratory of Molecular Biology, Lyon-Sud Hospital, Hospices Civils de Lyon, Pierre Bénite, France., Renault M; Department of Hematology, Lyon-Sud Hospital, Hospices Civils de Lyon, Pierre Bénite, France., Thérèse RM; Department of Hematology, Hôpital Brabois, CHRU Nancy and CNRS UMR 7365, Biopole de l'Université del Lorraine, Vendoeuvre les Nancy, France., Michallet M; Department of Hematology, Centre Léon Bérard, Lyon, France., Labussière-Wallet H; Department of Hematology, Lyon-Sud Hospital, Hospices Civils de Lyon, Pierre Bénite, France., Heiblig M; Department of Hematology, Lyon-Sud Hospital, Hospices Civils de Lyon, Pierre Bénite, France; Université Claude Bernard, Lyon, France. Electronic address: mael.heiblig@chu-lyon.fr.
Jazyk: angličtina
Zdroj: Transplantation and cellular therapy [Transplant Cell Ther] 2023 Jan; Vol. 29 (1), pp. 38.e1-38.e9. Date of Electronic Publication: 2022 Sep 13.
DOI: 10.1016/j.jtct.2022.09.003
Abstrakt: Allogeneic hematopoietic stem cell transplantation (allo-HSCT) after conditioning with a sequential association of fludarabine, amsacrine, and cytosine arabinoside (FLAMSA) followed by a reduced-intensity conditioning regimen has emerged for patients with high-risk acute myeloid leukemia (AML), especially in refractory or relapsing patients. Here we aimed to address retrospectively the impact of pretransplantation minimal residual disease (MRD) by flow cytometry on the outcomes of high-risk AML patients who underwent allo-HSCT after sequential FLAMSA-busulfan (FLAMSA-Bu)-based conditioning regimens. We included 165 high-risk AML patients who underwent transplantation after FLAMSA-BU in this retrospective single-center "real life" study. All patients received in vivo T cell depletion with antithymocyte globulin (5 mg/kg). MRD detection was based on a leukemia-associated immunophenotype using the European LeukemiaNet recommendations, with a threshold of .1%. Univariate and multivariate analyses were performed using R version 4.1.1 (R Foundation for Statistical Computing, Vienna, Austria). With a median follow-up of 4.0 years post-transplantation, the median overall survival (OS) was 54.9 months. Overall, 41 patients (24.8%) relapsed post-transplantation, with a resulting cumulative incidence of relapse (CIR) of 26.7% at 2 years and 34.0% at 5 years. Detectable MRD preceding allo-HSCT and refractory status were associated with worse median OS and CIR rates compared with patients without detectable MRD; however, OS was not significantly different between pre-HSCT MRD-positive and refractory patients (median, .7 year versus 2.0 years; P = .3). Conversely, pre-HSCT MRD negativity was associated with a reduced 2-year CIR. Neither European LeukemiaNet risk stratification nor age had a significant influence on OS. In the multivariate analysis, only pre-HSCT MRD positivity and lower conditioning regimen intensity were significantly associated with a poorer OS. The cumulative incidence of extensive chronic graft-versus-host disease at 2 years was 26.15%. The estimated nonrelapse mortality (NRM) of the entire cohort at 2 years was 23.1%, with age and unrelated donor identified as risk factors for higher NRM. Our data ahow that FLAMSA-Bu conditioning did not reverse the pejorative effect of detectable pre-HSCT MRD, suggesting that such patients should be offered alternative strategies before HSCT to reach deeper remission.
(Copyright © 2022 The American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
Externí odkaz: