Universität zu Köln

Ram, Ron, Scheid, Christof, Amit, Odelia, Chemnitz, Jens Markus, Moshe, Yakir, Hallek, Michael, Wolf, Dominik, Avivi, Irit and Holtick, Udo (2019). Sequential therapy or patients with primary refractory acute myeloid leukemia: a historical prospective analysis of the German and Israeli experience. Haematologica, 104 (9). S. 1798 - 1804. PAVIA: FERRATA STORTI FOUNDATION. ISSN 0390-6078

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Abstract

Primary refractory acute myeloid leukemia (AML) is associated with a dismal prognosis. The FLAMSA-reduced intensity conditioning protocol (total body irradiation or treosulfan-based) has been described as an effective approach in patients with refractory leukemia undergoing allogeneic hematopoietic cell transplantation. A modified protocol (without amsacrine) has also recently been used. We retrospectively analyzed the transplantation characteristics and outcomes of all consecutive patients between the years 2003 and 2017 (n=51) diagnosed with primary refractory AML who underwent transplantation at the University of Cologne and the Tel Aviv Medical Center. Median age was 54 years and median follow up was 37 months. Median time to neutrophil and platelet engraftment was 13 (range, 8-19) and 13 (range, 7-30) days, respectively. None of the patients had primary graft failure. Incidences of grade 2-4 and grade 3-4 acute graft-versus-host disease (GvHD), overall and moderate-severe chronic GvHD were 50% (95%CI: 41-67%), 12% (95%CI: 3-25%), 61% (95%CI: 47-72%), and 42% (95%CI: 34-51%), respectively. Anti-thymocyte globulin administration was associated with lower incidence of acute GvHD (FIR: 0.327; P=0.02). Non-relapse mortality at three months and three years were 6% and 16%, respectively. Relapse incidences were 6% and 29%, respectively. Overall survival rates at three months, three and five years were 90%, 61%, and 53%, respectively. Chronic GvHD disease was associated with a decreased mortality rate (HR 0.397; P=0.045). We conclude that sequential therapy in patients with primary refractory acute myeloid leukemia is safe and provides a remarkable anti-leukemic effect with durable survival and should be considered for every patient with primary refractory disease.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Ram, Ron UNSPECIFIED UNSPECIFIED UNSPECIFIED Scheid, Christof UNSPECIFIED UNSPECIFIED UNSPECIFIED Amit, Odelia UNSPECIFIED UNSPECIFIED UNSPECIFIED Chemnitz, Jens Markus UNSPECIFIED UNSPECIFIED UNSPECIFIED Moshe, Yakir UNSPECIFIED UNSPECIFIED UNSPECIFIED Hallek, Michael UNSPECIFIED UNSPECIFIED UNSPECIFIED Wolf, Dominik UNSPECIFIED UNSPECIFIED UNSPECIFIED Avivi, Irit UNSPECIFIED UNSPECIFIED UNSPECIFIED Holtick, Udo UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-143741
DOI:	10.3324/haematol.2018.203869
Journal or Publication Title:	Haematologica
Volume:	104
Number:	9
Page Range:	S. 1798 - 1804
Date:	2019
Publisher:	FERRATA STORTI FOUNDATION
Place of Publication:	PAVIA
ISSN:	0390-6078
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language STEM-CELL TRANSPLANTATION; MATCHED UNRELATED DONORS; HIGH-DOSE DAUNORUBICIN; VERSUS-HOST-DISEASE; INDUCTION; GLOBULIN; STANDARD; CHEMOTHERAPY; TREOSULFAN; REGIMEN Multiple languages Hematology Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/14374