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Allografting

Early allo-SCT for AML with a complex aberrant karyotype—results from a prospective pilot study

Bone Marrow Transplantation volume 47, pages 46–53 (2012)Cite this article

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.

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Acknowledgements

We thank Anne Franke, Munich, Angelika Cook, Wiesbaden and Silvia Soellner, Augsburg, for assistance in data collection.

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Authors and Affiliations

  1. Department of Medicine II, Stem Cell Transplantation Unit, Klinikum Augsburg, Ludwig-Maximilians-Universität München, Augsburg, Germany

    C Schmid, D Oruzio & G Schlimok

  2. Deutsche Klinik für Diagnostik, Wiesbaden, Germany

    M Schleuning, H Baurmann & R Schwerdtfeger

  3. Department of Medicine III, Klinikum der Ludwig-Maximilians-Universität München, Munich, Germany

    J Tischer, J Braess, K Spiekermann & W Hiddemann

  4. Department of Haematology and Oncology, University of Regensburg, Regensburg, Germany

    E Holler & J Hahn

  5. Departments of Anaesthesiology and Information Technology, Klinikum Augsburg, Ludwig-Maximilians-Universität München, Augsburg, Germany

    K-H Haude

  6. Münchner Leukämielabor, Munich, Germany

    C Haferlach

  7. Department of Haematology and Oncology, University of Münster, Münster, Germany

    T Buechner

  8. Department of Haematology and Oncology, Technical University of Munich, Munich, Germany

    H-J Kolb

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  1. C Schmid
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  2. M Schleuning
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  3. J Tischer
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  4. E Holler
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  7. C Haferlach
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Correspondence to C Schmid.

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Schmid, C., Schleuning, M., Tischer, J. et al. Early allo-SCT for AML with a complex aberrant karyotype—results from a prospective pilot study. Bone Marrow Transplant 47, 46–53 (2012). https://doi.org/10.1038/bmt.2011.15

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  • DOI: https://doi.org/10.1038/bmt.2011.15

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