title: Reduced-intensity conditioning with fludarabine and thiotepa for second allogeneic transplantation of relapsed patients with AML.
abstract: A second allograft was offered to 58 relapsed AML patients after conditioning with fludarabine 90-150 mg/m(2) and thiotepa 15 mg/kg, in most cases with active disease. Median age was 53 years (range 23-69), median time to relapse after the first allo-SCT was 326 (47-2189) days and median follow-up was 6.7 years. GVHD prophylaxis consisted mainly of CsA and alemtuzumab. Response rates at 1 month were CR in 50 and persistent disease in 3/53 evaluable patients. At 3 years, the relapse incidence (95% confidence interval) was 56 (45-71)%, the TRM 31 (21-46)%, the OS rate was 18 (9-29)% and the EFS rate was 13 (5-23)%. OS improved with younger patient age, longer relapse-free interval after the first allo-SCT and the development of chronic GVHD. Patients ≥ 65 years old who relapsed >12 months after the first allograft (n=20) had a 3-year OS rate of 41 (19-62)%. Conventional cytogenetics and FLT3 mutation status did not affect outcome. Our regimen is feasible and provides at least for a subgroup of patients with AML recurrence after allo-SCT a reasonable therapeutic option in an otherwise fatal situation. Further modifications and a better understanding of the underlying biology could help lower the risk of relapse.
authors: Allogeneic Stem Cell Transplantation Section, Department of Hematology/Oncology, University Medical Centre Freiburg, Freiburg, Germany.
authors: P
authors: P
authors: Christopoulos
authors: C
authors: C
authors: Schmoor
authors: M
authors: M
authors: Waterhouse
authors: R
authors: R
authors: Marks
authors: R
authors: R
authors: Wäsch
authors: H
authors: H
authors: Bertz
authors: J
authors: J
authors: Finke
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000517:prevention & control; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D019653:Myeloablative Agonists / Q000008:administration & dosage*; D012008:Recurrence; D012189:Retrospective Studies; D033581:Stem Cell Transplantation; D013852:Thiotepa / Q000008:administration & dosage*; D013997:Time Factors; D019172:Transplantation Conditioning / Q000379:methods*; D014740:Vidarabine / Q000008:administration & dosage / Q000031:analogs & derivatives*
chemical_list: D019653:Myeloablative Agonists; D013852:Thiotepa; D014740:Vidarabine; C024352:fludarabine