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Treatment of AML and MDS relapsing after reduced-intensity conditioning and allogeneic hematopoietic stem cell transplantation

Leukemia volume 21, pages 2540–2544 (2007)Cite this article

Disease relapse is the most important cause of treatment failure after allogeneic hematopoietic stem cell transplantation (HSCT) for patients with acute myelogenous leukemia (AML) and high-risk myelodysplastic syndrome (MDS).1 The risk of relapse is a function of several factors such as karyotype, disease status, preparative regimen intensity and the development of graft-versus-host disease (GVHD). The optimal therapy for recurrence is yet to be determined with most approaches eliciting dismal results. Chemotherapy and donor lymphocyte infusion (DLI) either alone or in combination, or second transplants have been used with different degrees of success.2, 3

Most studies describing outcomes after disease relapse in the context of reduced intensity conditioning (RIC) allogeneic transplantation involved heterogeneous groups of patients with small sample sizes. It is unclear to what extent patient selection explains the success or failure of salvage strategies. Here, we describe the outcomes of patients with AML and MDS relapsing after their first allogeneic HSCT (HSCT1) with reduced intensity or non-ablative preparative regimens. All patients were treated at the M D Anderson Cancer Center between June 1995 and December 2003. Preparative regimens consisted of either a non-ablative regimen of fludarabine, cytarabine and idarubicin (FAI), or with a reduced intensity regimen of fludarabine in combination with either melphalan (FM) or busulfan (FB). Donors were human leukocyte antigen (HLA)-compatible related or unrelated. Stem cell sources were peripheral blood or bone marrow. Complete remission (CR) before HSCT was defined as a normocellular bone marrow with less than 5% blasts and normal maturation of other marrow elements, absence of peripheral blood blasts and a platelet count greater than 100 × 109/l. CR after HSCT was defined using the same criteria except for platelet count, with donor cell engraftment.

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Authors and Affiliations

  1. Department of Stem Cell Transplantation and Cell Therapy, UT–MD Anderson Cancer Center, Houston, TX, USA

    B Oran, S Giralt, D Couriel, C Hosing, E J Shpall, E de Meis, I F Khouri, M Qazilbash, P Anderlini, P Kebriaei, U Popat, A Carrasco-Yalan, R E Champlin & M de Lima

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  1. B Oran
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  2. S Giralt
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  3. D Couriel
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  7. I F Khouri
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  14. M de Lima
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Correspondence to M de Lima.

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Oran, B., Giralt, S., Couriel, D. et al. Treatment of AML and MDS relapsing after reduced-intensity conditioning and allogeneic hematopoietic stem cell transplantation. Leukemia 21, 2540–2544 (2007). https://doi.org/10.1038/sj.leu.2404828

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