Marrow Transplantation in Patients with Acute Myeloid Leukemia in First Remission, First Relapse or Second Remission

Clift, Reginald A.; Cd, Buckner; Appelbaum, F; Petersen, Finn; Team, Seattle Marrow Transplant

doi:10.1007/978-3-642-76591-9_87

Cited by 132 publications

(178 citation statements)

References 7 publications

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“…Indeed, we know that increasing the dose of radiation in the conditioning regimen decreases the relapse incidence while increasing the toxicity [24]. Others have also demonstrated that because AML is less sensitive to a graft-versus-leukemia effect, some degree of dose intensity should be included in the conditioning regimen [19,25].…”

Section: Discussionmentioning

confidence: 99%

Outcome of conditioning intensity in acute myeloid leukemia with monosomal karyotype in patients over 45 year‐old: A study from the acute leukemia working party (ALWP) of the European group of blood and marrow transplantation (EBMT)

et al. 2015

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Acute myeloid leukemia with monosomal karyotype (MK AML) carries a very poor prognosis, even after allogeneic stem cell transplantation (SCT). However, SCT remains the only curative option in this high-risk population. Because myeloablative conditioning regimen (MAC) is associated with less relapse, we hypothesized that more intensive conditioning regimen might be beneficial for MK AML patients. We reviewed 303 patients over age 45 diagnosed with either de novo or secondary MK AML. One hundred and five patients received a MAC and 198 a reduced-intensity conditioning (RIC). The median age at SCT was 57-year-old, significantly lower in the MAC (53-year-old) than in the RIC group (59-year-old). The median followup was 42 months (range, 3 2 156 months). The 3-year overall survival (OS), leukemia-free survival (LFS), and relapse rate (RR) were not significantly different between both groups with overall values of 34%, 29%, and 51%, respectively. On the contrary, the 3-year nonrelapse mortality (NRM) was significantly higher in MAC recipients (28%) compared with RIC patients (16%, P 5 0.004). The incidence of Grades II to IV acute graftversus-host disease (GvHD) was significantly higher after a MAC (30.5%) than after a RIC (19.3%, P 5 0.02). That of chronic GvHD was comparable between both groups (35%) and did not impact on LFS. Interestingly, within our MK AML cohort, hypodiploidy was significantly associated with worse outcomes. Due to reduced toxicity and comparable OS, LFS, and RR, RIC appears as a good transplant option in the very high-risk population, including older patients, diagnosed with MK AML.

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Section: Discussionmentioning

confidence: 99%

Outcome of conditioning intensity in acute myeloid leukemia with monosomal karyotype in patients over 45 year‐old: A study from the acute leukemia working party (ALWP) of the European group of blood and marrow transplantation (EBMT)

et al. 2015

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“…14 The reduced intensity regimen used in our study consisted of Fludarabine (30 mg/m 2 /day X4) and BU (3.2 mg/kg/day X2 intravenously) with 200 cGy of TBI. The conventional intensity regimens used were IV Bu-Cy, 15 CY-TBI, 16 AraC-CY-TBI 17 and Flu-IV Bu-TBI 18 with no thymoglobulin. GVHD prophylaxis was CyA/MTX 19 or CyA/MMF 20 in related donor transplants and Alemtuzumab/CyA 21 in unrelated donor transplants (10 of 20 patients in CIC group and all 21 patients in RIC group).…”

Section: Treatmentmentioning

confidence: 99%

Impact of intensity of conditioning therapy in patients aged 40–60 years with AML/myelodysplastic syndrome undergoing allogeneic transplantation

Khabori

Elemary

et al. 2010

Bone Marrow Transplant

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The optimum intensity of conditioning therapy in patients aged 40-60 years with AML and myelodysplastic syndrome (MDS) undergoing allogeneic haematopoietic cell transplantation (alloHCT) remains uncertain. We compared outcomes of reduced intensity conditioning (RIC) and conventional intensity conditioning (CIC) in 101consecutive patients (CIC, 62; RIC, 39) with AML and MDS aged 40-60 years undergoing alloHCT from 2002 to 2008 at our centre. The median age, unrelated transplants and co-morbidity index were higher in the RIC group. Median OS and EFS were 31.0 months (95% confidence interval (CI): 12.8-59.3) and 20.7 months (95% CI: 11.0-30.4), respectively, with no significant difference between the two cohorts. The 3-year treatmentrelated mortality (TRM) and relapse were 28% (95% CI: 21-39) and 25% (95% CI: 17-36), respectively, with no significant difference between the two cohorts. No difference in OS, EFS, TRM or relapse was observed between the two cohorts in the multivariate model. Only disease risk was significantly associated with OS (Hazard ratio (HR): 1.85, CI: 1.01-3.45), EFS (HR: 1.73, 95% CI: 1.00-3.10) and cumulative relapse (HR: 3.24, 95% CI: 1.08-10.12). Disease biology rather than intensity of conditioning regimen seems to determine outcomes of alloHCT in patients aged 40-60 years with AML/MDS.

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“…[12][13][14][15][16][17] After myeloablative therapy, adult patients were nursed 513 in single rooms using simple reverse isolation measures, and pediatric patients were isolated in positive pressure rooms. PBPC or BM were reinfused after thawing on day 0.…”

Section: Patientsmentioning

confidence: 99%

Hematopoietic cell transplantation using plasma and DMSO without HES, with non-programmed freezing by immersion in a methanol bath: results in 213 cases

Hernández-Navarro

Ojeda

Arrieta

et al. 1998

Bone Marrow Transplant

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Summary:A simplified cryopreservation method for bone marrow (BM) and peripheral blood progenitor cells (PBPC) was utilized in hematopoietic cell transplantation of 213 patients with hematological or solid neoplasms after ablative chemotherapy (187 with peripheral blood progenitor cells and 26 with bone marrow). Cells were cryopreserved, after addition of autologous fresh plasma with DMSO, without HES, by freezing to ؊80؇C in a methanol bath and non-programmed freezer. For the patients autotransplanted with PBPC, the median period necessary for recovery of more than 0.5 × 10 9 /l granulocytes was 11 days (range 6-44), and 15 (8-204) days were required to obtain more than 20 × 10 9 /l platelets. For the patients autotransplanted with BM, the median period necessary to recover Ͼ0.5 × 10 9 /l granulocytes was 12 days (range 9-33), and 24 (12-57) days to obtain more than 20 × 10 9 /l platelets. These results support this method as being very effective in achieving high-quality cryopreservation. The procedure, which uses a non-programmed freezer, simplifies and reduces enormously the cost of the technical measures currently in use, enabling its adoption in almost any clinical oncological institution. Keywords: hematopoietic cell transplantation; cryopreservation; plasma and DMSO; non-programmed freezing; methanolThe transplantation of hematopoietic progenitor cells, derived both from bone marrow and peripheral blood, is an ever more frequent procedure in the treatment of numerous neoplastic diseases. The technology for this type of therapeutic procedure requires, in the majority of cases, the freezing and storage of these cells for variable periods of time. The freezing procedure is traditionally carried out using machinery which incorporates pre-established, comCorrespondence: Dr F Hernández-Navarro, Servicio Hematología y Hemoterapia, Hospital La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain Received 7 July 1997; accepted 21 October 1997 puterized freezing programs. 1-4 Experience using direct or non-programmed freezing systems for hemotopoietic progenitor cells and their transplant is less widespread. [5][6][7][8][9][10][11] In this article, we summarize our experience using a simple, non-programmed freezing method for the transplant of hematopoietic cells in patients with neoplastic disease. Two different in vitro experiments were designed to analyze the reproducibility and the effect of the methanol bath on freezing rates. Finally, a limited comparative study of in vitro cell viability following programmed and non-programmed freezing is also presented. Materials and methods Cooling ratesIn order to analyze the reproducibility of the cooling rates with the methanol system and the impact of this technique on the standardization of the freezing, two different in vitro experiments were performed.In the first (Figure 1), four different bags containing 160 ml of hematopoietic cells in 10% DMSO and autologous plasma were cryopreserved using a mechanical freezer at Ϫ80°C in a methanol bath as previously describe...

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Marrow Transplantation in Patients with Acute Myeloid Leukemia in First Remission, First Relapse or Second Remission

Cited by 132 publications

References 7 publications

Outcome of conditioning intensity in acute myeloid leukemia with monosomal karyotype in patients over 45 year‐old: A study from the acute leukemia working party (ALWP) of the European group of blood and marrow transplantation (EBMT)

Outcome of conditioning intensity in acute myeloid leukemia with monosomal karyotype in patients over 45 year‐old: A study from the acute leukemia working party (ALWP) of the European group of blood and marrow transplantation (EBMT)

Impact of intensity of conditioning therapy in patients aged 40–60 years with AML/myelodysplastic syndrome undergoing allogeneic transplantation

Hematopoietic cell transplantation using plasma and DMSO without HES, with non-programmed freezing by immersion in a methanol bath: results in 213 cases

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