title: Early allo-SCT for AML with a complex aberrant karyotype--results from a prospective pilot study.
abstract: In AML, a complex aberrant karyotype is associated with poor response to chemotherapy and dismal prognosis. We prospectively studied the concept of allogeneic haematopoietic SCT (HSCT), performed early and regardless of response to induction treatment in patients with complex karyotype AML (CK-AML). The preparative regimen consisted of fludarabine, Ara-C and amsacrine (FLAMSA) chemotherapy, followed by reduced intensity conditioning (RIC) 3 days later. In vivo T-cell depletion by anti-thymocyte globulin was used to protect from early GvHD, and prophylactic donor lymphocyte transfusion was given from day+120 to augment the GvL effect, once tolerance was established. Eighteen consecutive patients with CK-AML (median age: 53 years) received HSCT from related (n=7) or unrelated (n=11) donors. Before FLAMSA-RIC, nine patients each had received one and two induction courses. Stage at start of FLAMSA-RIC was CR/CRi (n=8) or persistent disease (n=10). Following HSCT, 16 patients achieved CR. After a follow-up of 51 months, 11 patients are alive in CR, whereas seven have died in remission (n=3), or from leukaemia (n=4). Cumulative incidence of relapse, non-relapse mortality, acute GvHD≥II and chronic GvHD were 0.222±0.098, 0.235±0.104, 0.367±0.120 and 0.481±0.123, respectively. Four-year survival from HSCT is 61%. Early HSCT following FLAMSA-RIC may improve the outcome of this unfavourable AML subgroup.
authors.affiliation: Stem Cell Transplantation Unit, Department of Medicine II, Klinikum Augsburg, Ludwig-Maximilians-Universität München, Augsburg, Germany. Christoph.Schmid@klinikum-augsburg.de
authors.forename: C
authors.initials: C
authors.lastname: Schmid
authors.forename: M
authors.initials: M
authors.lastname: Schleuning
authors.forename: J
authors.initials: J
authors.lastname: Tischer
authors.forename: E
authors.initials: E
authors.lastname: Holler
authors.forename: K-H
authors.initials: KH
authors.lastname: Haude
authors.forename: J
authors.initials: J
authors.lastname: Braess
authors.forename: C
authors.initials: C
authors.lastname: Haferlach
authors.forename: H
authors.initials: H
authors.lastname: Baurmann
authors.forename: D
authors.initials: D
authors.lastname: Oruzio
authors.forename: J
authors.initials: J
authors.lastname: Hahn
authors.forename: K
authors.initials: K
authors.lastname: Spiekermann
authors.forename: G
authors.initials: G
authors.lastname: Schlimok
authors.forename: R
authors.initials: R
authors.lastname: Schwerdtfeger
authors.forename: T
authors.initials: T
authors.lastname: Buechner
authors.forename: W
authors.initials: W
authors.lastname: Hiddemann
authors.forename: H-J
authors.initials: HJ
authors.lastname: Kolb
mesh_terms: D059786:Abnormal Karyotype; D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000677:Amsacrine / Q000008:administration & dosage / Q000009:adverse effects; D000961:Antilymphocyte Serum; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000009:adverse effects; D002648:Child; D003561:Cytarabine / Q000008:administration & dosage / Q000009:adverse effects; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000209:etiology / Q000235:genetics / Q000401:mortality / Q000473:pathology / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects; D015470:Leukemia, Myeloid, Acute / Q000235:genetics / Q000401:mortality / Q000473:pathology / Q000628:therapy; D008212:Lymphocyte Depletion / Q000009:adverse effects / Q000379:methods; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D015996:Survival Rate; D019172:Transplantation Conditioning / Q000009:adverse effects / Q000379:methods*; D014184:Transplantation, Homologous; D014740:Vidarabine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives
chemical_list: D000961:Antilymphocyte Serum; D007166:Immunosuppressive Agents; D000677:Amsacrine; D003561:Cytarabine; D014740:Vidarabine; C024352:fludarabine