title: Allogeneic hematopoietic cell transplantation with reduced-intensity conditioning following FLAMSA for primary refractory or relapsed acute myeloid leukemia.
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.
authors: Hematology and Oncology, Department of Medicine, University of Tuebingen, Tuebingen, Germany.
authors: Dominik
authors: D
authors: Schneidawind
authors: Birgit
authors: B
authors: Federmann
authors: Christoph
authors: C
authors: Faul
authors: Wichard
authors: W
authors: Vogel
authors: Lothar
authors: L
authors: Kanz
authors: Wolfgang Andreas
authors: WA
authors: Bethge
mesh_terms: D000368:Aged; D018572:Disease-Free Survival; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006650:Histocompatibility Testing; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D014184:Transplantation, Homologous / Q000379:methods*