Reduced-intensity conditioning with fludarabine and thiotepa for second allogeneic transplantation of relapsed patients with AML
| Autor: | Hartmut Bertz, Miguel Waterhouse, Reinhard Marks, Claudia Schmoor, Jürgen Finke, Ralph Wäsch, Petros Christopoulos |
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| Rok vydání: | 2013 |
| Předmět: |
Adult
Male medicine.medical_specialty Time Factors Transplantation Conditioning Graft vs Host Disease ThioTEPA Gastroenterology Recurrence Internal medicine medicine Humans Aged Retrospective Studies Transplantation business.industry Incidence (epidemiology) Retrospective cohort study Hematology Middle Aged Myeloablative Agonists medicine.disease Confidence interval Fludarabine Surgery Leukemia Myeloid Acute Leukemia Regimen Alemtuzumab Female business Thiotepa Vidarabine Follow-Up Studies Stem Cell Transplantation medicine.drug |
| Zdroj: | Bone Marrow Transplantation. 48:901-907 |
| ISSN: | 1476-5365 0268-3369 |
| Popis: | A second allograft was offered to 58 relapsed AML patients after conditioning with fludarabine 90-150 mg/m(2) and thiotepa 15 mg/kg, in most cases with active disease. Median age was 53 years (range 23-69), median time to relapse after the first allo-SCT was 326 (47-2189) days and median follow-up was 6.7 years. GVHD prophylaxis consisted mainly of CsA and alemtuzumab. Response rates at 1 month were CR in 50 and persistent disease in 3/53 evaluable patients. At 3 years, the relapse incidence (95% confidence interval) was 56 (45-71)%, the TRM 31 (21-46)%, the OS rate was 18 (9-29)% and the EFS rate was 13 (5-23)%. OS improved with younger patient age, longer relapse-free interval after the first allo-SCT and the development of chronic GVHD. Patients ≥ 65 years old who relapsed >12 months after the first allograft (n=20) had a 3-year OS rate of 41 (19-62)%. Conventional cytogenetics and FLT3 mutation status did not affect outcome. Our regimen is feasible and provides at least for a subgroup of patients with AML recurrence after allo-SCT a reasonable therapeutic option in an otherwise fatal situation. Further modifications and a better understanding of the underlying biology could help lower the risk of relapse. |
| Databáze: | OpenAIRE |
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