Abstract
There is substantial need to improve the outcome of patients with high-risk acute myeloid leukemia (AML). The clinical trial reported here investigated a new approach of up-front allogeneic hematopoietic stem cell transplantation (HSCT), provided a median of 40 days (range 22–74) after diagnosis, in twenty-six consecutive patients with newly-diagnosed high-risk AML characterized by poor-risk cytogenetics (n=19) or inadequate blast clearance by induction chemotherapy (IC, n=7). The median age was 49 years (range 17–68). During IC-induced aplasia after the 1st (n=11) or 2nd (n=15) cycle, patients received allogeneic peripheral blood stem cells (PBSC) from related (n=11) or unrelated (n=15) donors following a fludarabine-based reduced-intensity regimen. Seventeen patients were not in remission before HSCT with a median marrow blast count of 34% (range 6–70). All patients achieved rapid engraftment and went into remission with complete myeloid and lymphatic chimerism. Grades II to IV acute GvHD occurred in 14 (56%) and extensive chronic GvHD was documented in 8 (35%) patients. The probability of disease-free survival was 61% with only three patients relapsing 5, 6 and 7 months after transplantation, respectively. Up-front allogeneic HSCT as part of primary induction therapy seems to be an effective strategy in high-risk AML patients and warrants further investigation.
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Acknowledgements
We would like to thank the German bone marrow donor center (DKMS) for promoting the ‘fast search donor program’. This work was supported in part by grants of the Deutsche Krebshilfe 70-3197 (MB and CT) and 70-2980 (MB), presented orally as abstract at the EBMT meeting in Barcelona 2003.
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Platzbecker, U., Thiede, C., Füssel, M. et al. Reduced intensity conditioning allows for up-front allogeneic hematopoietic stem cell transplantation after cytoreductive induction therapy in newly-diagnosed high-risk acute myeloid leukemia. Leukemia 20, 707–714 (2006). https://doi.org/10.1038/sj.leu.2404143
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DOI: https://doi.org/10.1038/sj.leu.2404143
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