Sequential allogeneic hematopoietic stem cell transplantation for active refractory/relapsed myeloid malignancies: results of a reduced-intensity conditioning preceded by clofarabine and cytosine arabinoside, a retrospective study on behalf of the SFGM-TC.

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Abstrakt

Tytuł:: Sequential allogeneic hematopoietic stem cell transplantation for active refractory/relapsed myeloid malignancies: results of a reduced-intensity conditioning preceded by clofarabine and cytosine arabinoside, a retrospective study on behalf of the SFGM-TC.
Autorzy:: Le Bourgeois A; Department of Hematology, CHU Hôtel Dieu, Place A. Ricordeau, 44093, Nantes Cedex, France. .
Labopin M; Department of Hematology, Hôpital Saint Antoine, Sorbonne University and INSERM UMRs 938, Paris, France.
Marçais A; Department of Hematology, Hôpital Necker-Enfants Malades, Paris, France.
de Latour RP; Department of Hematology, Hôpital Saint Louis & Université Paris 7, Denis Diderot, Paris, France.
Blaise D; Department of Hematology, Centre de Recherche en Cancérologie de Marseille, Institut Paoli Calmettes, Marseille, France.
Chantepie S; Department of Hematology, CHU de Caen, Caen, France.
N'Guyen S; Department of Hematology, Hôpital Salpétrière, Paris, France.
Maillard N; Department of Hematology, Hôpital La Miletrie, Poitiers, France.
Forcade E; Department of Hematology, CHU de Bordeaux, Bordeaux, France.
Yakoub-Agha I; LIRIC INSERM U995, Université Lille 2, CHU de Lille, Lille, France.
Huynh A; Department of Hematology, CHU de Toulouse, Toulouse, France.
Marchand T; Department of Hematology, CHU de Rennes, Rennes, France.
Bilger K; Department of Hematology, CHU de Strasbourg, Strasbourg, France.
Ceballos P; Department of Hematology, CHU de Montpellier, Montpellier, France.
Charbonnier A; Department of Hematology, CHU d'Amiens Sud, Amiens, France.
Turlure P; Department of Hematology, CHU de Limoges, Limoges, France.
Rubio MT; Department of Hematology, CHU de Nancy, Nancy, France.
Béné MC; Department of Hematology, CHU Hôtel Dieu, Place A. Ricordeau, 44093, Nantes Cedex, France.
Guillaume T; Department of Hematology, CHU Hôtel Dieu, Place A. Ricordeau, 44093, Nantes Cedex, France.
Mohty M; Department of Hematology, Hôpital Saint Antoine, Sorbonne University and INSERM UMRs 938, Paris, France.
Chevallier P; Department of Hematology, CHU Hôtel Dieu, Place A. Ricordeau, 44093, Nantes Cedex, France. .
Corporate Authors:: Société Francophone de Greffe de Moelle et de Thérapie Cellulaire
Źródło:: Annals of hematology [Ann Hematol] 2020 Aug; Vol. 99 (8), pp. 1855-1862. Date of Electronic Publication: 2020 Jun 20.
Typ publikacji:: Clinical Trial; Journal Article; Multicenter Study
Język:: English
Imprint Name(s):: Publication: Berlin : Springer Verlag
Original Publication: Berlin ; New York : Springer International, c1991-
MeSH Terms:: Hematopoietic Stem Cell Transplantation*
Leukemia, Myeloid, Acute*/mortality
Leukemia, Myeloid, Acute*/therapy
Myelodysplastic Syndromes*/mortality
Myelodysplastic Syndromes*/therapy
Transplantation Conditioning*
Antineoplastic Combined Chemotherapy Protocols/*administration & dosage
Adolescent ; Adult ; Aged ; Allografts ; Clofarabine/administration & dosage ; Cytarabine/administration & dosage ; Disease-Free Survival ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Survival Rate
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Contributed Indexing:: Keywords: Acute myeloid leukemia; Allogeneic stem cell transplantation; Clofarabine; Reduced intensity conditioning regimen; Sequential regimen
Substance Nomenclature:: 04079A1RDZ (Cytarabine)
762RDY0Y2H (Clofarabine)
Entry Date(s):: Date Created: 20200622 Date Completed: 20200713 Latest Revision: 20210104
Update Code:: 20240105
DOI:: 10.1007/s00277-020-04074-7
PMID:: 32564196
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Allogeneic stem cell transplantation (allo-SCT) represents the most beneficial treatment for patients with active relapsed/refractory (R/R) hematologic malignancies. Recently, sequential regimens combining debulking chemotherapy followed by reduced-intensity conditioning (RIC) have shown encouraging results for these patients. In this retrospective study, we report the extended results of a sequential regimen of clofarabine, cytosine arabinoside, and RIC in 131 adults with active R/R myeloid disease at transplant. Conditioning consisted of clofarabine (30 mg/m 2 /day) and cytosine arabinoside (1 g/m 2 /day) for 5 days, followed, after a rest of 3 days, by an RIC combining cyclophosphamide (60 mg/kg) for 1 day, iv busulfan (3.2 mg/kg/day) for 2 days, and anti-thymocyte globulin (2.5 mg/kg/day) for 2 days. Between 2007 and 2016, 131 patients (males n = 75, median age: 52.6 years) were identified from the SFGM-TC registry. There were 111 acute myeloid leukemia (AML) patients and 20 cases with myelodysplastic or myeloproliferative syndrome. Status at transplant was known for all but 4 patients and was primary refractory (n = 81) and 1st or 2nd relapse (n = 46). All patients received allo-SCT from a matched donor (sibling n = 64, unrelated n = 67). Engraftment was observed in 105/122 (86%) evaluable cases and 63% of the patients achieved complete remission (CR) after transplant. The 1-year overall survival, disease-free survival, relapse incidence, non-relapse mortality, and graft-versus-host disease-free/relapse-free survival were 39.2%, 28.1%, 41.0%, 30.8%, and 22.2%, respectively. This study confirms that this sequential clofarabine-based regimen provides a high CR rate in this critical population, although relapse remains a matter of concern.

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