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Outcome after reduced-intensity conditioning allogeneic SCT for AML in first complete remission: comparison of two regimens

Bone Marrow Transplantation volume 42, pages 689–691 (2008)Cite this article

Standard myeloablative allogeneic SCT (allo-SCT) is a well-established therapy for patients with AML. However, because of the high incidence of transplant-related mortality, this procedure is limited to younger patients in good medical condition.1 Reduced-intensity conditioning (RIC) regimens have emerged as an attractive modality to decrease transplant-related mortality.2, 3 However, toxicity might represent only one aspect of the problem, as AML encompasses a group of chemosensitive diseases, raising concerns that significant reduction of the intensity of the preparative regimen may have a negative impact on long-term leukemic control.4, 5 Thus, investigators are currently faced with a dilemma on how to optimize the potential role of RIC allo-SCT in patients with AML while minimizing myeloablation-related toxicity and maximizing allogeneic immunotherapy. The aim of this report was to analyze retrospectively the outcome of 31 AML patients in first complete remission (CR1), who were treated according to two RIC allo-SCT approaches that differed in the intensity of chemotherapy delivered prior to and during the RIC regimen.

Between 2001 and 2006, 31 patients with AML in CR1 received an RIC allo-SCT in two different institutions (Institut Paoli-Calmettes, Marseille; FB2A1 group; n=18; and CHU de Nantes, Nantes; FB1A2 group; n=13). In the FB2A1 group, the post-remission strategy was to administer one course of high-dose Ara-C and an autologous SCT followed by RIC allo-SCT. In contrast, in the FB1A2 group, the post-remission therapy usually consisted of a single course of high-dose Ara-C followed by RIC allo-SCT. All 31 patients were contraindicated for a standard myeloablative allo-SCT because of age (>50) and/or comorbid conditions. All patients received allogeneic PBSCs mobilized with G-CSF from an HLA-identical sibling donor. The FB2A1 regimen consisted of fludarabine (30 mg/m2/d for 5–6 days), oral BU (total dose 8 mg/kg) and antithymocyte globulins (thymoglobulin; total dose 2.5 mg/kg). GVHD prophylaxis included CsA alone.6 On the other hand, the FB1A2 RIC regimen comprised fludarabine (30 mg/m2/d for 4 days) and lower doses of BU (4 mg/kg total dose) but higher doses of ATG (total dose 5 mg/kg). GVHD prophylaxis included both CsA and corticosteroids (methylprednisolone, 2 mg/kg/d from day −5 until day 30 post-allo-SCT).7 Supportive care is detailed elsewhere.8 Relapse, transplant-related mortality and GVHD incidences were calculated using the cumulative incidence method. Comparisons between subgroups were estimated by the Gray test. All data were computed using the R Package (R Development Core Team (2006). R: a language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. ISBN 3-900051-07-0, URL http://www.R-project.org). Patients' AML characteristics and transplant characteristics are summarized in Table 1. Except for age, there was no significant difference between the FB2A1 and the FB1A2 groups.

Table 1 Patients' leukemia and transplant characteristics
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References

  1. Sorror ML, Giralt S, Sandmaier BM, De Lima M, Shahjahan M, Maloney DG et al. Hematopoietic cell transplantation specific comorbidity index as an outcome predictor for patients with acute myeloid leukemia in first remission: combined FHCRC and MDACC experiences. Blood 2007; 110: 4606–4613.

    Article  CAS  Google Scholar 

  2. Champlin R, Khouri I, Komblau S, Molidrem J, Giralt S . Reinventing bone marrow transplantation. Nonmyeloablative preparative regimens and induction of graft-vs-malignancy effect. Oncology 1999; 13: 621–628; discussion 631, 635–8, 641.

    CAS  PubMed  Google Scholar 

  3. Storb R . Can reduced-intensity allogeneic transplantation cure older adults with AML? Best Pract Res Clin Haematol 2007; 20: 85–90.

    Article  Google Scholar 

  4. Lazarus HM, Rowe JM . Reduced-intensity conditioning for acute myeloid leukemia: is this strategy correct. Leukemia 2006; 20: 1673–1682.

    Article  CAS  Google Scholar 

  5. Blaise D, Vey N, Faucher C, Mohty M . Current status of reduced-intensity-conditioning allogeneic stem cell transplantation for acute myeloid leukemia. Haematologica 2007; 92: 533–541.

    Article  Google Scholar 

  6. Mohty M, de Lavallade H, Ladaique P, Faucher C, Vey N, Coso D et al. The role of reduced intensity conditioning allogeneic stem cell transplantation in patients with acute myeloid leukemia: a donor vs no donor comparison. Leukemia 2005; 19: 916–920.

    Article  CAS  Google Scholar 

  7. Michallet M, Bilger K, Garban F, Attal M, Huyn A, Blaise D et al. Allogeneic hematopoietic stem-cell transplantation after nonmyeloablative preparative regimens: impact of pretransplantation and posttransplantation factors on outcome. J Clin Oncol 2001; 19: 3340–3349.

    Article  CAS  Google Scholar 

  8. Mohty M, Jacot W, Faucher C, Bay JO, Zandotti C, Collet L et al. Infectious complications following allogeneic HLA-identical sibling transplantation with antithymocyte globulin-based reduced intensity preparative regimen. Leukemia 2003; 17: 2168–2177.

    Article  CAS  Google Scholar 

  9. Valcarcel D, Martino R, Caballero D, Martin J, Ferra C, Nieto JB et al. Sustained remissions of high-risk acute myeloid leukemia and myelodysplastic syndrome after reduced-intensity conditioning allogeneic hematopoietic transplantation: chronic graft-versus-host disease is the strongest factor improving survival. J Clin Oncol 2008; 26: 577–584.

    Article  CAS  Google Scholar 

  10. Shimoni A, Nagler A . Allogeneic hematopoietic stem-cell transplantation in patients with acute myeloid leukemia in first complete remission: new answers for an old question. Leukemia 2005; 19: 891–893.

    Article  CAS  Google Scholar 

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Acknowledgements

We thank the nursing staff for providing excellent care for our patients. MM and DB thank the ‘Association pour la Recherche sur le Cancer (ARC)’ (Pole ARECA), the ‘Fondation de France’, the ‘Fondation contre la Leucémie’, the ‘Agence de Biomédecine’, the ‘Association Cent pour Sang la Vie’ and the ‘Association Laurette Fugain’ for their generous and continuous support for our clinical and basic research work. Our groups are supported by several grants from the French Ministry of Health as part of the ‘Programme Hospitalier de Recherche Clinique (PHRC)’.

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Authors and Affiliations

  1. Service d'Hématologie, CHU de Nantes, Place A Ricordeau, Nantes, France

    X Cahu, M Mohty, P Chevalier, T Guillaume, J Delaunay, S Ayari, P Moreau & J L Harousseau

  2. Université de Nantes, Nantes, France

    M Mohty, P Moreau & J L Harousseau

  3. INSERM U892, Nantes, France

    M Mohty

  4. Département d'Hématologie, Institut Paoli-Calmettes, Marseille, France

    C Faucher, N Vey, J El-Cheikh, S Furst, J A Gastaut & D Blaise

  5. Univeristé de la Méditerrannée, Marseille, France

    J A Gastaut & D Blaise

  6. INSERM U599, Marseille, France

    D Blaise

  7. Previous affiliation during study period was Département d'Hématologie, Institut Paoli-Calmettes, Marseille, France

    M Mohty

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  1. X Cahu
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Correspondence to M Mohty.

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Cahu, X., Mohty, M., Faucher, C. et al. Outcome after reduced-intensity conditioning allogeneic SCT for AML in first complete remission: comparison of two regimens. Bone Marrow Transplant 42, 689–691 (2008). https://doi.org/10.1038/bmt.2008.231

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