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Allogeneic hematopoietic cell transplantation with reduced-intensity conditioning following FLAMSA for primary refractory or relapsed acute myeloid leukemia

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Abstract

Patients with primary refractory or relapsed acute myeloid leukemia (AML) have a dismal prognosis. We report a retrospective single center analysis of aplasia-inducing chemotherapy using fludarabine, cytarabine, and amsacrine (FLAMSA) followed by reduced-intensity conditioning (RIC) for allogeneic hematopoietic cell transplantation (HCT) in 62 consecutive primary refractory or relapsed AML patients. Two-year event-free survival and overall survival (OS) were 26 and 39 %, respectively. Risk stratification according to cytogenetic and molecular genetic markers showed superior survival in patients in the intermediate-1 risk group (2-year OS 70 %) compared to the intermediate-2 risk (2-year OS 34 %, p = 0.03) and adverse risk (2-year OS 38 %, p = 0.06) group. The use of HLA-matched versus HLA-mismatched donors had no significant influence on survival (p = 0.98). Two-year OS in the elderly subgroup defined by age ≥60 years was 31 % compared to 46 % in the group of younger patients <60 years (p = 0.19). Cumulative incidence of non-relapse mortality at 2 years adjusted for relapse as competing risk was 20 % for patients <60 years and 26 % for older patients (p = 0.55). Chronic graft-versus-host disease was associated with a statistically significant superior survival (p < 0.01). FLAMSA-RIC followed by allogeneic HCT enables long-term disease-free survival in primary refractory or relapsed AML even in the elderly patient population.

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Acknowledgments

The authors would like to thank Diana Kilian for maintaining our HCT database. We would also like to thank Susanne Scheible, Stem Cell Lab, University Children’s Hospital, Tuebingen for providing data about donor lymphocyte infusions.

Conflict of Interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Hematology and Oncology, Department of Medicine, University of Tuebingen, Tuebingen, Germany

    Dominik Schneidawind, Birgit Federmann, Christoph Faul, Wichard Vogel, Lothar Kanz & Wolfgang Andreas Bethge

  2. Hematology and Oncology, Department of Medicine, University Hospital Tuebingen, Otfried-Mueller-Straße 10, 72076, Tuebingen, Germany

    Wolfgang Andreas Bethge

Authors
  1. Dominik Schneidawind
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  2. Birgit Federmann
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  3. Christoph Faul
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  4. Wichard Vogel
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  5. Lothar Kanz
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  6. Wolfgang Andreas Bethge
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Correspondence to Wolfgang Andreas Bethge.

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DS and BF contributed equally to this manuscript.

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Schneidawind, D., Federmann, B., Faul, C. et al. Allogeneic hematopoietic cell transplantation with reduced-intensity conditioning following FLAMSA for primary refractory or relapsed acute myeloid leukemia. Ann Hematol 92, 1389–1395 (2013). https://doi.org/10.1007/s00277-013-1774-5

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  • DOI: https://doi.org/10.1007/s00277-013-1774-5

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