eprintid: 26373
rev_number: 12
eprint_status: archive
userid: 1589
dir: disk0/00/02/63/73
datestamp: 2019-06-18 14:20:01
lastmod: 2019-07-11 11:51:21
status_changed: 2019-06-18 14:20:01
type: article
metadata_visibility: show
creators_name: Saraceni, Francesco
creators_name: Labopin, Myriam
creators_name: Brecht, Arne
creators_name: Kröger, Nicolaus
creators_name: Eder, Matthias
creators_name: Tischer, Johanna
creators_name: Labussière-Wallet, Hélène
creators_name: Einsele, Hermann
creators_name: Beelen, Dietrich
creators_name: Bunjes, Donald
creators_name: Niederwieser, Dietger
creators_name: Bochtler, Tilmann
creators_name: Savani, Bipin N.
creators_name: Mohty, Mohamad
creators_name: 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)
subjects: ddc-610
divisions: i-910100
keywords: Acute myeloid leukemia (AML), Active disease, Allogeneic transplantation, Sibling donor (MSD), Unrelated donor (UD), Conditioning regimen, Fludarabine-treosulfan (FT), Thiotepa-busulfan-fludarabine (TBF), Fludarabine, intermediate dose Ara-C, amsacrine, total body irradiation/busulfan, cyclophosphamide (FLAMSA)
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 2 years 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.
date: 2019
publisher: BioMed Central
id_scheme: DOI
ppn_swb: 1668942291
own_urn: urn:nbn:de:bsz:16-heidok-263736
language: eng
bibsort: SARACENIFRFLUDARABIN2019
full_text_status: public
publication: Journal of Hematology & Oncology
volume: 12
number: 44
place_of_pub: London
pagerange: 1-10
issn: 1756-8722
citation:   Saraceni, Francesco ; Labopin, Myriam ; Brecht, Arne ; Kröger, Nicolaus ; Eder, Matthias ; Tischer, Johanna ; Labussière-Wallet, Hélène ; Einsele, Hermann ; Beelen, Dietrich ; Bunjes, Donald ; Niederwieser, Dietger ; Bochtler, Tilmann ; Savani, Bipin N. ; Mohty, Mohamad ; Nagler, Arnon  (2019) 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).  Journal of Hematology & Oncology, 12 (44).  pp. 1-10.  ISSN 1756-8722     
document_url: https://archiv.ub.uni-heidelberg.de/volltextserver/26373/1/13045_2019_Article_727.pdf