Impact of Blood Count Recovery-based Complete Remission Before Allogeneic Hematopoietic Stem Cell Transplantation on Survival in Patients With Acute Myeloid Leukemia

2019 ◽  
Vol 19 (5) ◽  
pp. e205-e212
Author(s):  
Rafiye Ciftciler ◽  
Haluk Demiroglu ◽  
Yahya Buyukasık ◽  
Salih Aksu ◽  
Hakan Goker
Keyword(s):  
Acute Myeloid Leukemia ◽  
Stem Cell ◽  
Hematopoietic Stem Cell Transplantation ◽  
Complete Remission ◽  
Stem Cell Transplantation ◽  
Myeloid Leukemia ◽  
Blood Count ◽  
Hematopoietic Stem ◽  
Acute Myeloid ◽  
Count Recovery

scholarly journals αβ-T-cell-depleted haploidentical hematopoietic stem cell transplantation in children with chemorefractory acute myeloid leukemia

2019 ◽  
Vol 18 (2) ◽  
pp. 11-21
Author(s):  
L. N. Shelikhova ◽  
M. A. Ilushina ◽  
K. V. Semiglazova ◽  
Zh. B. Shekhovtsova ◽  
D. A. Shasheleva ◽  
...  
Keyword(s):  
Acute Myeloid Leukemia ◽  
Stem Cell ◽  
T Cell ◽  
Hematopoietic Stem Cell Transplantation ◽  
Complete Remission ◽  
Stem Cell Transplantation ◽  
Cumulative Incidence ◽  
Myeloid Leukemia ◽  
Hematopoietic Stem ◽  
Acute Myeloid

Primary refractory and relapsed refractory acute myeloid leukemia remains an unresolved problem in pediatric oncology. Children with AML who fail to achieve complete remission on high-dose cytarabine and antracyclines have no chance for survival without allogeneic hematopoietic stem cell transplantation. We evaluated the outcome of αβ-T-cell-depleted haploidentical transplantation in a cohort of children with chemorefractory acute myeloid leukemia. Thirty-six patients with either primary refractory (n = 14) or relapsed refractory (n = 22) acute myeloid leukemia in active disease status received a transplantation from haploidentical donors. The preparative regimen included cytoreduction with fludarabine and cytarabine and subsequent treatment with treosulfan and either melphalan or thiophosphamide. Serotherapy consisted of antithymocyte globuline in 14 pts and targeted immunomodulation with tocilizumab +/- abatacept in 22 pts. Grafts were PBSCs engineered by TCR-αβ/CD19 depletion. Posttransplant preemptive therapy included modified donor lymphocyte infusions with or without hypomethylating agents. Complete remission was achieved in 30 (83%) рts. The cumulative incidence of acute GVHD grade II–IV was 25%, and the cumulative incidence of chronic GVHD was 18%. Transplant-related mortality was 6%, and relapse incidence was 48%. Event-free survival was 46%, and overall survival was 41% at 2 years. Good early recovery of NK cells was associated with significantly improved survival and decreased relapse incidence. Our data suggest that αβ-T-cell-depleted haploidentical HSCT provides a reasonable chance of cure in a cohort of children with chemorefractory acute myeloid leukemia and creates a solid basis for further improvement. The study was approved by the Independent Ethics Committee of the Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology, and Immunology.

Superiority of Haploidentical Related Hematopoietic Stem-Cell Transplantation Over Chemotherapy Alone for Patients with Intermediate- or Poor- Risk Acute Myeloid Leukemia in First Complete Remission,

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 4161-4161
Author(s):  
Yingjun Chang ◽  
Honghu Zhu ◽  
Lanping Xu ◽  
Hao Jiang ◽  
Daihong Liu ◽  
...  
Keyword(s):  
Acute Myeloid Leukemia ◽  
Stem Cell ◽  
Hematopoietic Stem Cell Transplantation ◽  
Complete Remission ◽  
Stem Cell Transplantation ◽  
Myeloid Leukemia ◽  
Hematopoietic Stem ◽  
Poor Risk ◽  
First Complete Remission ◽  
Acute Myeloid

Abstract Abstract 4161 Purpose: The role of HLA-haploidentical related donors (HRD) hematopoietic stem-cell transplantation (HSCT) in first complete remission (CR1) for adults with intermediate and poor risk acute myeloid leukemia (AML) is still not clear. Patients and Methods: Totally 428 newly diagnosed AML patients between 15 and 60 years old were studied between Jan 2006 and May 2010. Among 240 patients with intermediate and poor risk cytogenetics, 191patients achieved CR1 and received chemotherapy alone or HSCT as post-remission treatment. Of these, 141 patients received chemotherapy alone (n=78) or HRD HSCT (n=63) were analyzed. Results: Up to last follow-up time of May 2011, 44 out of 141 patients died (36 died of relapse and 8 died of TRM) and 97 patients are still alive. 49 out of 141 patients experienced relapse and 84 patients are still in continuous CR1. The cumulative incidence of relapse (CIR) at 4 years was 37.4%±4.4%. Overall survival(OS) and disease-free survival(DFS) at 4 year was 63.8%±5.0% and 55.5%±4.9%, respectively. The CIR of HRD HSCT group was significantly lower than chemotherapy group(12.8%±6.1% vs.57.4%±5.6%, p<0.0001). HRD HSCT improved survival achieved by chemotherapy alone significantly (DFS at 4 years, 71.8%±6.9% v 42.6%±6.1%, p<0.0001;OS at 4 years,75.7% ±7.0% v 54.6%±6.1%, p=0.0014). Univariate and multivariate analysis showed post-remission treatment choice (HRD HSCT or chemotherapy) and high WBC at diagnosis were independent risk factor affecting relapse, DFS and OS. Conclusion: HRD HSCT in CR1 is superior to chemotherapy alone for adults with intermediate and poor risk AML patients. Disclosures: No relevant conflicts of interest to declare.

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