Autologous stem cell transplantation versus alternative allogeneic donor transplants in adult acute leukemias

Gorin, Norbert Claude

doi:10.1053/j.seminhematol.2016.01.003

Cited by 10 publications

(5 citation statements)

References 39 publications

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“…Although many reports show positive results in the favorable-risk group [1–5] and in selected patients with non-favorable karyotypes [6–10], the role of AUTO-HCT still remains unclear, and the procedure fell out of fashion in clinical trials. In contrast, allogeneic-HCT is regarded as a curative option for adult AML patients in their first complete remission (CR1), especially in the intermediate- and poor-risk groups, which showed lower relapse rates showing graft-versus-leukemia (GVL) effect compared to AUTO-HCT or chemotherapy alone [11–13].…”

Section: Introductionmentioning

confidence: 99%

Long-term clinical outcomes of hematopoietic cell transplantation for intermediate-to-poor-risk acute myeloid leukemia during first remission according to available donor types

et al. 2017

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Standard therapy for acute myeloid leukemia (AML) consists of hematopoietic cell transplantation (HCT) including autologous-HCT (AUTO) and allogeneic-HCT from a matched-sibling donor (MSD) or well-matched unrelated donor (WM-URD). When a conventional donor is not available, HCT from a partially-matched (PM)-URD or familial-mismatched donor (FMMD) is typically considered. We analyzed 561 patients with intermediate to poor-risk molecular cytogenetics who underwent transplant from 2002 to 2013 in their first remission. Engraftment was successful in all donor types except five patients who died in aplasia. Disease-free survival (DFS) at 5 years was 61.4% for MSD, 62.1% for WM-URD, 65.3% for FMMD, 44.7% for AUTO and 36.8% for PM-URD. AUTO showed the highest relapse rate (51.0%) compared to MSD (23.5%) and FMMD (18.5%), but showed the lowest 5-year non-relapse mortality (NRM) rate (3.8%). PM-URD showed the highest NRM (29.3%) with more instances of acute graft-vs.-host disease (GVHD) with grade≥III (29.3%), compared to MSD (15.6%) and FMMD (15.7%). In a poor-risk subgroup, the 5-year DFS for FMMD and MSD was 59.8% and 46.7%, respectively, while for AUTO and PM-URD it was 12.6% and 0.0%, respectively, which was caused by a high relapse rate (87.1% in AUTO, 83.3% in PM-URD). In the intermediate-risk subgroup, the 5-year DFS of AUTO (53.9% was not different from the conventional donors in multivariate analysis, presenting a low NRM rate (5.1%). FMMD should be considered prior to PM-URD in intermediate-to-poor-risk AML and GVHD prophylaxis should be intensified when PM-URD is needed. AUTO might be considered for selected patients in the intermediate-risk group.

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Section: Introductionmentioning

confidence: 99%

Long-term clinical outcomes of hematopoietic cell transplantation for intermediate-to-poor-risk acute myeloid leukemia during first remission according to available donor types

et al. 2017

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“…The 2‐year LFS, OS, and NRM were 60% vs 26% ( P = .005), 76% vs 26% ( P = .001) and 4% vs 43% ( P < .001) in the ASCT vs haplo‐HSCT groups, respectively. 28 These findings indicated that ASCT could be considered as an effective consolidation therapy in CR1 ALL patients at standard risk or with Philadelphia chromosome.…”

Section: Indicationsmentioning

confidence: 93%

“…There was no significant difference in the 2‐year LFS, OS and relapse rate between the two groups. 28 Further subgroup analysis found that Ph + ALL patients in CR1 benefited more from ASCT compared with haplo‐HSCT. The 2‐year LFS, OS, and NRM were 60% vs 26% ( P = .005), 76% vs 26% ( P = .001) and 4% vs 43% ( P < .001) in the ASCT vs haplo‐HSCT groups, respectively.…”

Section: Indicationsmentioning

confidence: 99%

“…Hematopoietic reconstitution was achieved in all patients except for one patient who died early. The median time of neutrophil and platelet reconstitution was 11 days 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 and 16 days 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 ,…”

Section: Conditioning Regimensmentioning

confidence: 99%

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Optimizing Autologous Hematopoietic Stem Cell Transplantation for Acute Leukemia

Pang

Huo

Shen

et al. 2021

Stem Cells Translational Medicine

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Autologous hematopoietic stem cell transplantation (ASCT) remains an important postremission treatment for acute leukemia (AL). It is known that some prognostic factors, such as age, cytogenetic and molecular risk stratification, and minimal residual disease (MRD) status, are closely related to clinical outcomes following ASCT. Moreover, there are multiple measurements, including pretransplant treatment, stem cell mobilization and collection, conditioning regimens, and maintenance treatment after transplantation, that can affect prognosis after ASCT. Our clinical practice of ASCT should be better standardized to further improve patient outcomes. This review outlines optimization and quality control measures for ASCT developed at the Institute of Hematology and Blood Diseases Hospital of the Chinese Academy of Medical Sciences, the first established and largest autologous stem cell transplant center in China. These measures will enhance the development of best practices and strategies for AL ASCT therapies, thereby improving patient outcomes.

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“…On the other hand, for patients with core-binding-factor AML, i.e., AML with t (8;21); AML with inv (16) or t (16;16); and an NPM1 mutation in absence of an FLT3 mutation or with FLT3 low allelic burden, ELN recommends, after induction, up to four courses of ID/HDARAC, even though it remains unclear whether ID or HDARAC of two or three course would be preferred [15,16]. Numerous studies have demonstrated that ASCT could be offered to younger patients in the favorable and intermediate cytogenetic risk groups with results not inferior to ID/HDARAC in terms of relapse occurrence and survival [17][18][19][20][21][22][23][24][25]. Relapse remains a major cause of treatment failure ASCT, and in most cases it occurs within the first 2 years after transplantation.…”

Section: Post Remission Therapymentioning

confidence: 99%

Is There Still a Role for Autologous Stem Cell Transplantation for the Treatment of Acute Myeloid Leukemia?

Ferrara

Picardi

2019

Cancers

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After intensive induction chemotherapy and complete remission achievement, patients with acute myeloid leukemia (AML) are candidates to receive either high-dose cytarabine-based regimens, or autologous (ASCT) or allogeneic (allo-SCT) hematopoietic stem cell transplantations as consolidation treatment. Pretreatment risk classification represents a determinant key of type and intensity of post-remission therapy. Current evidence indicates that allo-SCT represents the treatment of choice for high and intermediate risk patients if clinically eligible, and its use is favored by increasing availability of unrelated or haploidentical donors. On the contrary, the adoption of ASCT is progressively declining, although numerous studies indicate that in favorable risk AML the relapse rate is lower after ASCT than chemotherapy. In addition, the burden of supportive therapy and hospitalization favors ASCT. In this review, we summarize current indications (if any) to ASCT on the basis of molecular genetics at diagnosis and minimal residual disease evaluation after induction/consolidation phase. Finally, we critically discuss the role of ASCT in older patients with AML and acute promyelocytic leukemia.

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Autologous stem cell transplantation versus alternative allogeneic donor transplants in adult acute leukemias

Cited by 10 publications

References 39 publications

Long-term clinical outcomes of hematopoietic cell transplantation for intermediate-to-poor-risk acute myeloid leukemia during first remission according to available donor types

Long-term clinical outcomes of hematopoietic cell transplantation for intermediate-to-poor-risk acute myeloid leukemia during first remission according to available donor types

Optimizing Autologous Hematopoietic Stem Cell Transplantation for Acute Leukemia

Is There Still a Role for Autologous Stem Cell Transplantation for the Treatment of Acute Myeloid Leukemia?

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