@article{SantoroLabopinGiannottietal.2018, author = {Santoro, Nicole and Labopin, Myriam and Giannotti, Federica and Ehninger, Gerard and Niederwieser, Dietger and Brecht, Arne and Stelljes, Matthias and Kr{\"o}ger, Nicolaus and Einsele, Herman and Eder, Matthias and Hallek, Michael and Glass, Bertram and Finke, J{\"u}rgen and Ciceri, Fabio and Mohty, Mohamad and Ruggeri, Annalisa and Nagler, Arnon}, title = {Unmanipulated haploidentical in comparison with matched unrelated donor stem cell transplantation in patients 60 years and older with acute myeloid leukemia: a comparative study on behalf of the ALWP of the EBMT}, series = {Journal of Hematology \& Oncology}, volume = {11}, journal = {Journal of Hematology \& Oncology}, doi = {10.1186/s13045-018-0598-0}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-227315}, pages = {55, 1-10}, year = {2018}, abstract = {Background: Acute myeloid leukemia (AML) is both more common and with more biologically aggressive phenotype in the elderly. Allogenic stem cell transplantation (allo-SCT) is the best treatment option in fit patients. Either HLA-matched unrelated donor (MUD) or haploidentical (Haplo) donor are possible alternative for patients in need. Methods: We retrospectively compared non-T-cell-depleted Haplo (n = 250) to 10/10 MUD (n = 2589) in AML patients >= 60 years. Results: Median follow-up was 23 months. Disease status at transplant differs significantly between the two groups (p < 10(-4)). Reduced intensity conditioning (RIC) was administrated to 73 and 77\% of Haplo and MUD, respectively (p = 0.23). Stem cell source was the bone marrow (BM) in 52\% of the Haplo and 6\% of MUD (p < 10(-4)). Anti-thymocyte globulin (ATG) was most frequently used in MUD (p < 10(-4)) while post-Tx cyclophosphamide (PT-Cy) was given in 62\% of Haplo. Engraftment was achieved in 90\% of the Haplo vs 97\% of MUD (p < 10(-4)). In multivariate analysis, no significant difference was found between Haplo and MUD for acute (a) graft versus host disease (GVHD) grade II-IV, relapse incidence (RI), non-relapse mortality (NRM), leukemia free survival (LFS), graft-versus-host-free-relapse free survival (GRFS), and overall survival (OS). Extensive chronic (c) GVHD was significantly higher for MUD as compared to Haplo (HR 2, p = 0.01, 95\% CI 1.17-3.47). A propensity score analysis confirmed the higher risk of extensive cGVHD for MUD without differences for other outcomes. Conclusions: Allo-SCT from both Haplo and MUD are valid option for AML patients >= 60 years of age with similar results. Transplantation from MUD was associated with higher extensive cGVHD. Our findings suggest that Haplo is a suitable and attractive graft source for patients >= 60 with AML in need of allo-SCT.}, language = {en} } @article{SaraceniLabopinBrechtetal.2019, author = {Saraceni, Francesco and Labopin, Myriam and Brecht, Arne and Kr{\"o}ger, Nicolaus and Eder, Matthias and Tischer, Johanna and Labussiere-Wallet, Helene and Einsele, Hermann and Beelen, Dietrich and Bunjes, Donald and Niederwieser, Dietger and Bochtler, Tilman and Savani, Bipin N. and Mohty, Mohamad and Nagler, Arnon}, title = {Fludarabine-treosulfan compared to thiotepa-busulfan-fludarabine or FLAMSA as conditioning regimen for patients with primary refractory or relapsed acute myeloid leukemia: a study from the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation (EBMT)}, series = {Journal of Hematology \& Oncology}, volume = {12}, journal = {Journal of Hematology \& Oncology}, number = {44}, doi = {10.1186/s13045-019-0727-4}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-227345}, pages = {1-10}, year = {2019}, abstract = {Background Limited data is available to guide the choice of the conditioning regimen for patients with acute myeloid leukemia (AML) undergoing transplant with persistent disease. Methods We retrospectively compared outcome of fludarabine-treosulfan (FT), thiotepa-busulfan-fludarabine (TBF), and sequential fludarabine, intermediate dose Ara-C, amsacrine, total body irradiation/busulfan, cyclophosphamide (FLAMSA) conditioning in patients with refractory or relapsed AML. Results Complete remission rates at day 100 were 92\%, 80\%, and 88\% for FT, TBF, and FLAMSA, respectively (p=0.13). Non-relapse mortality, incidence of relapse, acute (a) and chronic (c) graft-versus-host disease (GVHD) rates did not differ between the three groups. Overall survival at 2years was 37\% for FT, 24\% for TBF, and 34\% for FLAMSA (p=0.10). Independent prognostic factors for survival were Karnofsky performance score and patient CMV serology (p=0.01; p=0.02), while survival was not affected by age at transplant. The use of anti-thymocyte globulin (ATG) was associated with reduced risk of grade III-IV aGVHD (p=0.02) and cGVHD (p=0.006), with no influence on relapse. Conclusions In conclusion, FT, TBF, and FLAMSA regimens provided similar outcome in patients undergoing transplant with active AML. Survival was determined by patient characteristics as Karnofsky performance score and CMV serology, however was not affected by age at transplant. ATG appears able to reduce the incidence of acute and chronic GVHD without influencing relapse risk.}, language = {en} }