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Published on: March 26, 2018
Early allo-SCT for AML with a complex aberrant karyotype--results from a prospective pilot study
C Schmid1, M Schleuning, J Tischer
1Stem Cell Transplantation Unit, Department of Medicine II, Klinikum Augsburg, Ludwig-Maximilians-Universität München, Augsburg, Germany. Christoph.Schmid@klinikum-augsburg.de
Early allogeneic hematopoietic stem cell transplant (HSCT) using FLAMSA-RIC conditioning offers improved survival for acute myeloid leukemia (AML) patients with complex karyotypes, even with persistent disease. This approach may overcome the poor prognosis associated with this AML subtype.
Area of Science:
- Hematology
- Oncology
- Stem Cell Transplantation
Background:
- Complex aberrant karyotype in acute myeloid leukemia (AML) correlates with poor treatment response and prognosis.
- Allogeneic hematopoietic stem cell transplantation (HSCT) is a potential curative option for high-risk AML.
Purpose of the Study:
- To evaluate the efficacy and safety of early allogeneic HSCT with a fludarabine, Ara-C, and amsacrine (FLAMSA) chemotherapy followed by reduced intensity conditioning (RIC) in patients with complex karyotype AML (CK-AML).
Main Methods:
- Prospective study of 18 consecutive CK-AML patients undergoing HSCT with FLAMSA-RIC.
- In vivo T-cell depletion with anti-thymocyte globulin and prophylactic donor lymphocyte transfusion were utilized.
- Patients received HSCT regardless of response to prior induction chemotherapy.
Main Results:
- 16 out of 18 patients achieved complete remission (CR) post-HSCT.
- Four-year survival from HSCT was 61%, with 11 patients alive in CR after a median follow-up of 51 months.
- Cumulative incidence of relapse was 0.222, and non-relapse mortality was 0.235.
Conclusions:
- Early HSCT utilizing FLAMSA-RIC conditioning may improve outcomes for patients with CK-AML.
- This strategy demonstrates feasibility and potential efficacy in an unfavorable AML subgroup.
- Further investigation is warranted to confirm these findings in larger cohorts.
