TY  - JOUR
A1  - Saraceni, Francesco
A1  - Labopin, Myriam
A1  - Brecht, Arne
A1  - Kröger, Nicolaus
A1  - Eder, Matthias
A1  - Tischer, Johanna
A1  - Labussiere-Wallet, Helene
A1  - Einsele, Hermann
A1  - Beelen, Dietrich
A1  - Bunjes, Donald
A1  - Niederwieser, Dietger
A1  - Bochtler, Tilman
A1  - Savani, Bipin N.
A1  - Mohty, Mohamad
A1  - Nagler, Arnon
T1  - 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)
JF  - Journal of Hematology & Oncology
N2  - 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.
KW  - Acute myeloid leukemia (AML)
KW  - Active disease
KW  - Allogeneic transplantation
KW  - Sibling donor (MSD)
KW  - Unrelated donor (UD)
KW  - Conditioning regimen
KW  - Fludarabine-treosulfan (FT)
KW  - Thiotepa-busulfan-fludarabine (TBF)
KW  - Fludarabine
KW  - intermediate dose Ara-C
KW  - amsacrine
KW  - total body irradiation/busulfan
KW  - cyclophosphamide (FLAMSA)
Y1  - 2019
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-227345
VL  - 12
IS  - 44
ER  -