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

Logo poskytovatele
Logo poskytovatele

Varování

Publikace nespadá pod Ekonomicko-správní fakultu, ale pod Lékařskou fakultu. Oficiální stránka publikace je na webu muni.cz.
Autoři

KREJČÍ Marta DOUBEK Michael DUŠEK Jaroslav BRYCHTOVÁ Yvona RÁČIL Zdeněk NAVRÁTIL Milan TOMIŠKA Miroslav HORKÝ Ondřej POSPÍŠILOVÁ Šárka MAYER Jiří

Rok publikování 2013
Druh Článek v odborném periodiku
Časopis / Zdroj Annals of hematology
Fakulta / Pracoviště MU

Lékařská fakulta

Citace
www http://dx.doi.org/10.1007/s00277-013-1790-5
Doi http://dx.doi.org/10.1007/s00277-013-1790-5
Obor Onkologie a hematologie
Klíčová slova Acute myeloid leukemia; Reduced-intensity conditioning; Fludarabine; Cytarabine; Amsacrine; Allogeneic transplantation
Přiložené soubory
Popis Sequential use of chemotherapy and reduced-intensity conditioning (RIC) with allogeneic stem cell transplantation (SCT) has been proposed to improve the treatment outcomes in patients with high-risk acute myeloid leukemia (AML). Here, we present our experience with this procedure in a cohort of 60 AML patients with primary induction failure (n=9); early, refractory, or >= second relapse (n=41); or unfavorable cytogenetics (n=10). A combination of fludarabine (30 mg/m(2)/day), cytarabine (2 g/m(2)/day), and amsacrine (100 mg/m(2)/day) for 4 days was used. After 3 days of rest, RIC was carried out, consisting of 4 Gy total body irradiation, antithymocyte globulin (ATG-Fresenius), and cyclophosphamide (fludarabine, amsacrine, and cytarabine (FLAMSA)-RIC protocol). Prophylactic donor lymphocyte infusions (pDLIs) were given in patients with complete remission (CR) and without evidence of graft-versus-host disease >= 120 days after SCT. The median time of neutrophil engraftment was 17 days. CR was achieved in 47 of 60 patients (78 %). Eleven patients received pDLIs resulting in longterm CR in eight of them. Non-relapse mortality after 1 and 3 years was 25 and 28 %, respectively. With a median follow-up of 37 months (range, 10-69), 3-year overall survival and 3-year progression-free survival were 42 and 33%, respectively. In a multivariate analysis, dose of CD34(+) cells >5x10(6)/kg (p=0.005; hazard ratio (HR)=0.276), remission of AML before SCT (p=0.044; HR=0.421), and achievement of complete chimerism after SCT (p=0.001; HR=0.205) were significant factors of better overall survival. The use of the FLAMSA-RIC protocol in suitable high-risk AML patients results in a long-term survival rate of over 40 %.
Související projekty:

Používáte starou verzi internetového prohlížeče. Doporučujeme aktualizovat Váš prohlížeč na nejnovější verzi.