Combination of fludarabine, amsacrine, and cytarabine followed by reduced-intensity conditioning and allogeneic hematopoietic stem cell transplantation in patients with high-risk acute myeloid leukemia

Krejčí, Marta; Doubek, Michael; Dusek, J; Brychtová, Yvona; Ráčil, Zdeněk; Navrátil, Milan; Tomíška, Miroslav; Horký, Ondřej; Pospı́šilová, Šárka; Mayer, Jiřı́

doi:10.1007/s00277-013-1790-5

Cited by 21 publications

(27 citation statements)

References 28 publications

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“…The 3-year OS achieved 69.2% in total patients, 74.5% in those in CR1, and 56.3% in those refractory to induction therapy or beyond CR1. These results are favorable when comparing with the published studies [37][38][39][40]. Thus it suggests that IDA-BUCY2 regimen may serve as superior conditioning regimen to BUCY2 regimen for high-risk AML, even if larger samples would have allowed for more powerful conclusions.…”

Section: Discussionsupporting

confidence: 55%

Idarubicin-intensified BUCY2 conditioning regimen improved survival in high-risk acute myeloid, but not lymphocytic leukemia patients undergoing allogeneic hematopoietic stem cell transplantation: A retrospective comparative study

et al. 2016

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Section: Discussionsupporting

confidence: 55%

Idarubicin-intensified BUCY2 conditioning regimen improved survival in high-risk acute myeloid, but not lymphocytic leukemia patients undergoing allogeneic hematopoietic stem cell transplantation: A retrospective comparative study

et al. 2016

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“…17 Considering the very advanced characteristics of our patients (HCT-CI ⩾ 3: 63%, age ⩾ 60 years: 45%; refractory disease: 50%; previous Allo-HSCT: 17%), the cumulative incidence of NRM (27% at 1 year) seems comparable to the results observed in the setting of HLA-identical Allo-HSCT for advanced diseases and/or high-risk patients. 16,18,19 We suggest that the use of PT-Cy explained in part this result. Indeed, PT-Cy was reported as effective GVHD prophylaxis, contributing to the overall improvement of outcomes after Haplo-SCT.…”

Section: Discussionmentioning

confidence: 78%

“…We suppose that these results could be improved in AML patients with standard risk (that is, Intermediate cytogenetics AML in CR1), but to date, very few data of PT-Cy Haplo-SCT are available in this specific setting. The others series reporting the results of PT-Cy Haplo-SCT in the specific fields of AML or MDS included few patients (18)(19)(20)(21)(22)(23)(24)(25), with various proportion of refractory diseases (36-100%). [25][26][27] They found a PFS ranging from 39 to 72%.…”

Section: Discussionmentioning

confidence: 99%

T-replete haploidentical allogeneic transplantation using post-transplantation cyclophosphamide in advanced AML and myelodysplastic syndromes

Devillier

Bramanti

Fürst

et al. 2015

Bone Marrow Transplant

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Unmanipulated haploidentical transplantation (Haplo-SCT) using post-transplantation cyclophosphamide (PT-Cy) represents an alternative for patients with high-risk diseases lacking HLA-identical donor. Although it provides low incidences of GVHD, the efficacy of Haplo-SCT is still questioned, especially for patients with myeloid malignancies. Thus, we analyzed 60 consecutive patients with refractory (n = 30) or high-risk CR (n = 30) AML or myelodysplastic syndromes (MDSs) who underwent PT-Cy Haplo-SCT. The median age was 57 years (22-73 years), hematopoietic cell transplantation comorbidity index was ⩾ 3 in 38 patients (63%) and Haplo-SCT was the second allogeneic transplantation for 10 patients (17%). Although most of patients received PBSC as graft source (n = 48, 80%), we found low incidences of grade 3-4 acute (2%) and severe chronic GVHD (4%). Among patients with high-risk CR diseases, 1-year non-relapse mortality, cumulative incidence of relapse, progression-free and overall survivals were 20%, 32%, 47% and 62%, respectively. In patients with refractory disease, corresponding results were 34%, 35%, 32% and 37%, respectively. We conclude that PT-Cy Haplo-SCT could provide promising anti-leukemic effect even in the setting of very advanced diseases. Thus, it represents a viable alternative for high-risk AML/MDS patients without HLA-identical donor.

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“…The 3-year rates of TRM among MRD-negative remission, MRD-positive remission, and NR groups were 10.6%, 17.9% and 24.7%. This compares favorably with myeloablative conditioning allo-HSCT, which is associated with TRM rates of around 40% and with those of 28% to 33% in the sequential FLAMSA strategy (fludarabine (4 £ 30 mg/m 2 ), amsacrine (4 £ 100 mg/m 2 ), and Ara-C (4 £ 2 g/m 2 )) [35][36][37]. These data provide rationale that IDA-intensified conditioning would potentiate the antileukemic effects of conditioning while retaining sufficient tolerability.…”

Section: Discussionmentioning

confidence: 96%

Idarubicin-Intensified Hematopoietic Cell Transplantation Improves Relapse and Survival of High-Risk Acute Leukemia Patients with Minimal Residual Disease

Zhang

Wang

et al. 2019

Biology of Blood and Marrow Transplantation

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The optimal conditioning regimen of allogeneic hematopoietic stem cell transplantation (allo-HSCT) for high-risk patients with minimal residual disease (MRD) remains controversial. We studied the results in 98 high-risk acute leukemia patients transplanted with idarubicin (IDA)-intensified conditioning regimens between 2012 January and 2017 January. Among these patients, 31 (31.6%) had more than 5% marrow blasts at time of transplantation and 67 patients were in morphologic remission: MRD negative status at time of conditioning was achieved in 39 patients (39.8%), whereas 28 (28.6%) remained carriers of any other positive MRD level in the bone marrow. Three-year relapse estimates of patients with MRD-positive remission was 22.0%, which was remarkably lower than patients with active disease (45.4%, P = .027) but approximate to that of patients in MRD-negative remission (15.5%, P = .522). There were no significant differences in terms of 3-year estimated overall survival (OS) and disease-free survival (DFS) between MRD-positive remission and MRD-negative remission groups (71.4% versus 79.1% [P = .562] and 67.9% versus 76.9% [P = .634], respectively). Moreover, the estimated rates of 3-year OS and DFS of patients in MRD-positive remission were significantly better than those in patients with active disease (71.4% versus 41.9% [P = .033] and 67.9% versus 38.7% [P = .037], respectively). These data indicate that IDA-intensified conditioning allo-HSCT could overcome the negative prognostic impact of MRD.

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Combination of fludarabine, amsacrine, and cytarabine followed by reduced-intensity conditioning and allogeneic hematopoietic stem cell transplantation in patients with high-risk acute myeloid leukemia

Cited by 21 publications

References 28 publications

Idarubicin-intensified BUCY2 conditioning regimen improved survival in high-risk acute myeloid, but not lymphocytic leukemia patients undergoing allogeneic hematopoietic stem cell transplantation: A retrospective comparative study

Idarubicin-intensified BUCY2 conditioning regimen improved survival in high-risk acute myeloid, but not lymphocytic leukemia patients undergoing allogeneic hematopoietic stem cell transplantation: A retrospective comparative study

T-replete haploidentical allogeneic transplantation using post-transplantation cyclophosphamide in advanced AML and myelodysplastic syndromes

Idarubicin-Intensified Hematopoietic Cell Transplantation Improves Relapse and Survival of High-Risk Acute Leukemia Patients with Minimal Residual Disease

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