EPOCH-F: A Novel Salvage Regimen for Multiple Myeloma Prior to Reduced-Intensity Allogeneic Stem Cell Transplantation

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 4328-4328
Author(s):  
Saad Jamshed ◽  
Daniel Fowler ◽  
Sattva Neelapu ◽  
Robert M. Dean ◽  
Seth M Steinberg ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Allogeneic Stem Cell Transplantation ◽  
Chronic Gvhd ◽  
Cd4 Count ◽  
Salvage Regimen ◽  
Chemotherapeutic Regimen ◽  
Reduced Intensity

Abstract Variation in baseline host immune status contributes to inconsistent donor engraftment and may impede maximal graft-versus-myeloma effects after reduced-intensity allogeneic stem cell transplantation (RI-alloSCT) for advanced multiple myeloma. We performed a phase II study to determine the efficacy of a novel salvage regimen, EPOCH-F, which was designed to provide immune depletion and disease control prior to RI-alloSCT, in 22 patients with advanced multiple myeloma. EPOCH is an infusional chemotherapeutic regimen consisting of etoposide, vincristine and adriamycin, with prednisone, cyclophosphamide and fludarabine and given in 21 day cycles prior to RI-alloSCT. Patients received at least 1 and no more than 5 cycles of EPOCH-F gudied by peripheral blood CD4+ T cell count. Pts achieving adequate lymphodepletion proceeded to RI-alloSCT; otherwise patients proceeded to RI-alloSCT after 5 cycles or if there was disease progression during EPOCH-F, regardless of CD4 count. Median age was 53 years (range, 36–65); median time from initial therapy to transplant was 12 months (range, 2–168). Median number of prior therapies was 2 (range, 1–8), while 63% had chemotherapy sensitive disease. 68% of patients had received a novel agent. Patients received a median of 3 cycles (range, 1–5) of EPOCH-F. Therapy was well tolerated with manageable toxicities, mostly hematologic. Neutropenia (grade IV) was the most common toxicity seen in 77% of the administered cycles with only 6 episodes of neutropenic fever. Median lymphocyte count decreased from 1423/μL (range, 335–2788) to 519/μL (range, 102–1420); CD4 count decreased from 320/μL (range, 130–1366) to 115/μL (range, 30–309). In 21 evaluable patients, the overall response rate to EPOCH-F was 22% and 68% had stable disease. 13% of patients achieved CR/nCR. Only 1 patient progressed while on therapy. 20 patients received allograft from HLA matched sibling donors and were evaluable for engraftment. Median Day 100 chimerism was 100% (range 60–100, mean 95). 70% of patients achieved ≥VGPR including CR/nCR, while CR/nCR was seen in 40% of the patients. Median overall survival was 46.1 months. 10 (50%) patients are currently alive. Acute GVHD (grade II–IV) was seen in 47% and chronic GVHD (grade III–IV) was seen in 52% of patients. Treatment-related mortality at 100 days was 5% and 30% at 60 months. EPOCH-F is an active regimen which facilitates consistent and rapid full donor engraftment following RI-alloHSCT from related donors in patients with advanced multiple myeloma.

Two-Year Follow-Up Results at the M.D. Anderson Hospital with Reduced-Intensity Allogeneic Stem Cell Transplantation with Fludarabine-Melphalan as Preparative Regimen in Relapsed/Refractory Hodgkin’s Lymphoma: Comparable Outcome with Matched Related and Unrelated Donors.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 3115-3115 ◽  
Author(s):  
Paolo Anderlini ◽  
Rima M. Saliba ◽  
Sandra Acholonu ◽  
Sergio A. Giralt ◽  
Issa F. Khouri ◽  
...  
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Allogeneic Stem Cell Transplantation ◽  
Hodgkin’S Lymphoma ◽  
Chronic Gvhd ◽  
Complete Response ◽  
Hodgkin's Lymphoma ◽  
Unrelated Donors ◽  
Reduced Intensity

Abstract BACKGROUND: Allogeneic stem cell transplantation (allo-SCT) with reduced-intensity conditioning (RIC) is gaining increasing acceptance in relapsed/refractory (R/R) Hodgkin’s lymphoma (HL), but there are little or no outcome data with matched unrelated donors (MUDs). METHODS: Fifty-eight patients with relapsed or refractory Hodgkin’s lymphoma (HL) underwent allogeneic stem cell transplantation (allo-SCT) following a reduced-intensity conditioning (RIC) regimen from a matched related donor (MRD; n=25) or a matched unrelated donor (MUD; n=33). The median age was 32 years (range 19–59). The median number of chemotherapy regimens received prior to allo-SCT was five (range 2–9). Forty-eight (83%) patients had received a prior autologous (auto) SCT. The median time to progression after auto-SCT was five months (1–34). Disease status at SCT was sensitive relapse (n=30) or refractory relapse (n=28). The conditioning regimen employed was fludarabine (125–130 mg/m sq over 4–5 days), melphalan (140 mg/m sq IV over 2 days) (FM) and antithymocyte globulin (thymoglobulin 6 mg/kg over 3 days) was added for the most recent fourteen MUD transplants. Graft-vs-host disease (GVHD) prophylaxis included tacrolimus and mini-methotrexate. RESULTS: Chimerism studies indicated 100% donor-derived engraftment in all patients (100%). Cumulative 100-day and 2-year transplant-related mortality (TRM) were 7% and 15%, respectively, (100-day TRM MRD vs. MUD 6% vs. 8%, p=ns; 2-year MRD vs. MUD 13% vs. 16%, p=ns). The cumulative incidence of acute (grade II–IV) GVHD (first 100 days) was 28% (MRD vs. MUD 12% vs. 39%, p=0.04). The cumulative incidence of chronic GVHD at any time was 74% (MRD vs. MUD 57% vs. 89%, p=0.003). Fourteen pts (24%) received a total of 25 (range 1–5) donor leukocyte infusions (DLIs) for disease progression/relapse (PD). Five of them (35%) received salvage chemotherapy as well, and nine (64%) developed acute GVHD after the DLI. Thirty-six patients (62%) are alive (23 in remission) with a median follow-up of 24 months (4–78). The f/up is 23 months (4–53) for alive pts always in remission. Twenty-two patients (38%) expired, and relapse-related mortality was 24%. Projected 2-year overall (OS) and progression-free (PFS) survival are 64% (49–76) and 32% (20–45), with projected 2-year PD at 55% (43–70). There was no statistically significant difference between MRD and MUD transplants with regard to OS (p=0.1), PFS (p=0.9) and PD (p=0.8). There was a clear trend for the response status prior to allo-SCT (complete response, complete response undefined vs. all others) to favorably impact PFS (p=0.07) and PD (p=0.049), but not OS (p=0.4). Partial responders and patients with stable or refractory disease fared similarly with regard to OS and PFS. CONCLUSIONS: Despite the expected higher incidence of acute and chronic GVHD, MUD RIC allo-SCTs had TRM, PFS, and OS comparable to MRD allo-SCTs. Day 100, 2-year TRM and OS/PFS data appear very encouraging in these very high-risk, extensively pretreated patients. Response status at transplant seems to affect outcome, and PD remains a major obstacle. The use of unrelated donors would greatly expand donor availability for these patients.

Unrelated stem cell transplantation in multiple myeloma after a reduced-intensity conditioning with pretransplantation antithymocyte globulin is highly effective with low transplantation-related mortality

Blood ◽  
2002 ◽  
Vol 100 (12) ◽  
pp. 3919-3924 ◽  
Author(s):  
Nicolaus Kröger ◽  
Herbert Gottfried Sayer ◽  
Rainer Schwerdtfeger ◽  
Michael Kiehl ◽  
Arnon Nagler ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Antithymocyte Globulin ◽  
Chronic Gvhd ◽  
Progression Free Survival ◽  
Reduced Intensity Conditioning ◽  
Free Survival ◽  
Reduced Intensity

We investigated the feasibility of unrelated stem cell transplantation in 21 patients with advanced stage II/III multiple myeloma after a reduced-intensity conditioning regimen consisting of fludarabine (150 mg/m2), melphalan (100-140 mg/m2), and antithymocyte globulin (ATG; 10 mg/kg on 3 days). The median patient age was 50 years (range, 32-61 years). All patients had received at least one prior autologous transplantation, in 9 cases as part of an autologous-allogeneic tandem protocol. No graft failure was observed. At day 40 complete donor chimerism was detected in all patients. Grade II to IV acute graft-versus-host disease (GVHD) was seen in 8 patients (38%), and severe grade III/IV GVHD was observed in 4 patients (19%). Six patients (37%) developed chronic GVHD, but only 2 patients (12%) experienced extensive chronic GVHD. The estimated probability of nonrelapse mortality at day 100 was 10% and at 1 year was 26%. After allografting, 40% of the patients achieved a complete remission, and 50% achieved a partial remission, resulting in an overall response rate of 90%. After a median follow-up of 13 months, the 2-year estimated overall and progression-free survival rates are 74% (95% CI, 54%-94%) and 53% (95% CI, 29%-87%), respectively. A shorter progression-free survival was seen in patients who already experienced relapse to prior autograft (26% versus 86%, P = .04). Dose-reduced conditioning with pretransplantation ATG followed by unrelated stem cell transplantation provides durable engraftment and donor chimerism, reduces substantially the risk of transplant-related organ toxicity, and induces high remission rates.

Reduced intensity allogeneic stem cell transplantation in patients with myelodysplastic syndrome: Does the conditioning matter? A retrospective study of the SFGM-TC on 61 patients

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 6547-6547
Author(s):  
L. Terriou ◽  
Z. Chir ◽  
H. Esperou ◽  
J. Boiron ◽  
N. Gratecos ◽  
...  
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Myelodysplastic Syndrome ◽  
Cell Transplantation ◽  
Allogeneic Stem Cell Transplantation ◽  
Chronic Gvhd ◽  
Immunosuppressive Treatment ◽  
Conditioning Regimen ◽  
The Impact ◽  
Reduced Intensity

6547 Background: Reduced-intensity allogeneic stem cell transplantation (RIT) has emerged as an alternative to myeloablative transplantation in pts with myelodysplastic syndrome (MDS). Given the uncertainty regarding the appropriate conditioning, SFGM-TC conducted a retrospective multicenter study with the attempt to evaluate the impact of conditioning on pts’ outcome. Methods: The record of 61 pts (37 males) with MDS who received a RIT between 1998 and 2003, from 22 French transplantation centres, were reviewed. According to the FAB classification, 11 pts had RA at diagnosis, of whom one had progressed to REAB and one to AML before transplantation. Thirty-two pts had REAB, of whom 2 had progressed to REAB-T and 7 to AML. Twelve pts had REAB-T and 6 CMML, of whom 8 progressed to AML. The median time from diagnosis to RIT was 12 months (6–129). Conditioning regimen consisted of fludarabin (Flu) plus busulfan ( n=29), Flu plus 2-Gy TBI ( n=20) and idarubicin plus aracytine and Flu (n=12). Donors were HLA-identical siblings (n=52) and HLA-matched unrelated (n=9). All pts received peripheral blood stem cells. The median of CD34+ infused cell dose was 5 × 106/kg (0.5–17.3). Results: At the reference date of 1 July 2005, median follow-up was 44.7 months (21–85). Estimated 3-year overall survival (OS), progression free survival (PFS), relapse and transplant-relapse mortality (TRM) were 35%, 27%, 66% and 30%, respectively. Neither of the 3 conditioning regimens used had impact on pts’ outcome. In multivariable analyses, while acute III/IV grade GVHD development was the only factor found to adversely influencing OS (HR=3.6; 95% CI: 1.1–12.2), chronic GVHD development was the only favourably influencing PFS and relapse ratios (HR=0.3; 95% CI: 0.1–0.7 and HR=0.2; 95% CI: 0.1–0.6, respectively). TRM was adversely influenced by male sex of pt (HR=9.2; 95% CI: 1.5–66.6). Conclusions: RIT seems to be an effective treatment in MDS pts irrespective of conditioning type. While acute III/IV grade GVHD appeared to be detrimental, the benefit effect of chronic GVHD was to be bound to GVL effect. New approaches with focus on immunosuppressive treatment are needed to enhance the GVL effect with an acceptable risk of GVHD. No significant financial relationships to disclose.

Death of frontline allo-SCT in myeloma

Blood ◽  
2012 ◽  
Vol 119 (26) ◽  
pp. 6178-6179 ◽  
Author(s):  
Philippe Moreau
Keyword(s):  
Multiple Myeloma ◽  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Allogeneic Stem Cell Transplantation ◽  
Reduced Intensity Conditioning ◽  
No Donor ◽  
Comparison Trial ◽  
Frontline Therapy ◽  
Reduced Intensity

In this issue of Blood, Lokhorst et al report the results of a donor versus no-donor comparison trial, which unambiguously establishes that reduced intensity conditioning allogeneic stem cell transplantation (RIC allo-SCT) should not be offered as part of frontline therapy in multiple myeloma (MM).1

Pilot Study of Reduced-Intensity Conditioning Followed by Allogeneic Stem Cell Transplantation in Patients with Myelofibrosis.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 1512-1512
Author(s):  
Nicolaus Kroeger ◽  
Tatjana Zabelina ◽  
Heike Schieder ◽  
Jens Panse ◽  
Francis Ayuk ◽  
...  
Keyword(s):  
Stem Cell ◽  
Pilot Study ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Allogeneic Stem Cell Transplantation ◽  
Chronic Gvhd ◽  
Disease Free Survival ◽  
Allogeneic Transplantation ◽  
Reduced Intensity Conditioning ◽  
Reduced Intensity

Abstract We evaluated in a prospective pilot- study the effect of reduced intensity conditioning with busulfan (10 mg/kg), fludarabine (150 mg/m²) and anti-thymocyte globulin followed by allogeneic stem cell transplantation from related and unrelated donors in 14 patients with myelofibrosis. Study objectives were engraftment, chimerism, treatment- related mortality (TRM) and response. The median age of the patients was 51 (range, 32 – 63) years. According the Lille score there were low risk (n=4), intermediare risk (n= 7) and high risk (n=3) The median time until leukocyte (> 1.0 x 109/l) and platelet (> 20 x 109/l) engraftment was 16 (range, 11 – 26) days and 26 (range, 9 – 139) days, respectively. No graft failure occurred. Complete donor chimerism on day 100 was seen in 13 patients (93%). Acute graft-versus host disease (GvHD) grade II-IV occurred in 50% and grade III/IV 29 % of the patients. The incidence of chronic GvHD was 54 %. Two patients died due to treatment complications, resulting in a TRM at one year of 15% (95% CI: 0–35%). Hematological response after allogeneic transplantation was seen in all patients and complete histopathological remission was observed in 90%of patients. After a median follow-up of 13 (range, 3 – 48) months, the 3-years estimated overall and disease-free survival is 85 % (95 % CI: 65–100 %).

Allogeneic Stem Cell Transplantation (allo-SCT) from a HLA Identical Sibling for CR1 AML Patients Aged above 55 Years Old after a Reduced Intensity Conditioning: A Survey from the Société Française de Greffe de Moelle et de Thérapie Cellulaire (SFGM-TC).

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 1140-1140
Author(s):  
Didier Blaise ◽  
Zina Chir ◽  
Michel Attal ◽  
Jean-Henri Bourhis ◽  
Jean-Jacques Sotto ◽  
...  
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Allogeneic Stem Cell Transplantation ◽  
Chronic Gvhd ◽  
High Survival ◽  
Reduced Intensity Conditioning ◽  
Preparative Regimen ◽  
The Impact ◽  
Reduced Intensity

Abstract Background: AML incidence increases with age. Allogeneic stem cell transplantation (Allo-SCT) offers the best leukemic control but is associated with high non-relapse mortality (NRM). Recent advances using non-myeloablative strategies have established the feasibility of allo-SCT in elderly patients. However in the context of AML, an important reduction of the intensity of the preparative regimen may be also associated with a loss of leukemic control, offsetting the impact of toxicity reduction in elderly. Methods: We retrospectively analyzed AML patients in first complete remission (CR1) reported to the SFGM-TC, aged above 55 and transplanted from a HLA identical sibling donor prior to 01/01/05. Results: 62 patients prepared with a non-myeloablative conditioning (NMAC) (fludarabine (75mg/m2) + TBI (2Gy)) (N=14) or a reduced intensity conditioning (RIC) (busulfan (4 to 8 mg/m2) + fludarabine (150 to 180 mg/m2) + thymoglobulin (2.5 to 12.5 mg/m2)) (N=48). GVHD prophylaxis used CSA+MMF for NMAC, CSA +/− MMF for RIC. With few exceptions, all patients in a given centre were treated identically. Major characteristics were: age 58 (55–67), M/F= 27/35. Time between diagnosis and allo-SCT: 171 days (101–467). BMT/PBSCT: 7/55. Pts have been considered for allo-SCT because of poor prognosis factors: no favorable cytogenetics (100%), secondary AML (15%), 2 chemotherapy course to achieve CR1 (24%) or M0, M6 or M7 FAB (20%). All pts engrafted. Acute GVHD occurred in 16 pts (grade 1: 6; grade 2: 6; grade 3–4: 4) and chronic GVHD in 18 pts (limited: 8; extensive: 10) with no difference in the 2 groups. The cumulative incidences of grade 2–4 aGVHD and cGVHD were 16% (95%CI: 7–25) and 29% (95%CI: 18–40) respectively. 15 pts relapsed and 8 died from NRM. Relapse and NRM cumulative incidences were 24% (95%CI: 13–35) and 13% (95%CI: 5–21) respectively. 49 pts were evaluable for cGVHD: of the 18 expressing cGVHD none have relapsed as compared to 12 of the 31 who did not present cGVHD (39%, 95%CI: 22–56) (p=.007). The 2 year KM survival and DFS probabilities are 63% (47–76) and 56% (42–69). In a landmark analysis investigating patients alive on day 100, 2 year DFS are 94% and 38% respectively with or without cGVHD (p=0.001) and 2 year KM OS are respectively 94% and 45% (p=0.01). Conclusions: We conclude that such a strategy in elderly can afford a high relapse control with low NRM conducting to high survival probability at 2 years. Results are achieved through the allogeneic effect as expressed by cGVHD inviting to a careful immunomodulation in the early post transplant period to further improve results.

Anti-Thymocyte Globulin Induces Higher Response Rates and Less Graft-Versus-Host Disease in Multiple Myeloma Patients Undergoing Allogeneic Stem Cell Transplantation.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 2980-2980
Author(s):  
Francis Ayuk ◽  
José A. Perez-Simon ◽  
Avichai Shimoni ◽  
Anna Sureda ◽  
Tatjana Zabelina ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Allogeneic Stem Cell Transplantation ◽  
Chronic Gvhd ◽  
Conditioning Regimen ◽  
Response Rates ◽  
Separate Analysis ◽  
Significant Prognostic Factor

Abstract Preclinical experiments have shown a strong anti-myeloma effect of polyclonal anti-thymo-cyte globulin (ATG). We evaluated ATG effect in a melphalan/fludarabine-based conditioning regimen in 138 multiple myeloma (MM) patients who underwent allogeneic stem cell transplantation with (n=79) or without (n=59) ATG. More patients in the group without ATG had experienced relapse to prior auto-transplant (63% vs. 47%, p = 0.08). Patient characteristics were otherwise well matched in both groups. A median ATG dose of 30 mg/kg BW (range, 10-90 mg/kg BW) was administered on days −3 to −1. GvHD prophylaxis was performed with cyclosporine A and short-course methotrexate. Overall response (93% vs. 78%, p=0.03) and complete response (59% vs. 39%, p=0.04) at day 100 were higher in the patients treated with ATG than in those without ATG. ATG led to a lower incidence of severe grade III/IV acute GvHD (11% vs. 22%, p=0.10), and chronic GvHD (23% vs. 65%, p<0.001). The rate of complete remissions increased in patients who had received the higher ATG dose: 57% in those who received ATG ≤ 30 mg/kg BW, vs. 63% in those who received ATG > 30 mg/kg BW. The rate of OR increased from 78% in the no-ATG group to 91% in patients who received ATG ≤ 30 mg/kg BW, and to 96% in patients who received ATG > 30 mg/kg BW (p=0.02). Separate analysis of patients transplanted from a sibling donor also showed a trend to better OR (86% vs. 78%) and CR (55% vs. 39%) for patients who received ATG (all patients received ATG at a dose ≤ 30 mg/kg) compared to the non-ATG group, however due to low numbers this difference did not reach statistical significance. Though the non-ATG group contained more patients who had relapsed to prior autografting, this as has been reported before, would not influence response rates. In the multivariate analysis of prognostic factors for achievement of a CR, ATG was the only significant prognostic factor (RR: 2.57; 95% CI: 1.17-5.64; P=0.02). The estimated overall survival (OS) at three years was 53% (95% CI: 40-66%) for the ATG group (p=0.46), and 43% (95% CI: 29-57%) for the non-ATG group (p=0.46), while progression-free survival (PFS) at three years was 39% (95% CI: 27-51%) for the ATG group, and 27% (95% CI: 14-40%), for the non-ATG group (p=0.55). The current results suggest a dose dependent beneficial effect of ATG in terms of myeloma cytotoxicity as well reduction of the incidence of chronic GvHD.

Unrelated Stem Cell Transplantation After Reduced Intensity Conditioning for Patients with Multiple Myeloma Relapsing After Autologous Transplantation A Prospective Multicenter Phase II Study of the Chronic Leukemia Working Party of the European Group for Blood and Marrow Transplantation (EBMT).

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 2308-2308
Author(s):  
Nicolaus Kröger ◽  
Avichai Shimoni ◽  
Georgia Schilling ◽  
Rainer Schwerdtfeger ◽  
Martin Bornhäuser ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Allogeneic Stem Cell Transplantation ◽  
Cumulative Incidence ◽  
Unrelated Donor ◽  
Unrelated Donors ◽  
Reduced Intensity

Abstract Abstract 2308 Poster Board II-285 Introduction: Dose-reduced conditioning followed by allogeneic stem cell transplantation has become a treatment option for patients with multiple myeloma. However, the experience using unrelated donor is limited. Patients and Methods: From 2002 to 2007, 49 myeloma patients with relapse to a prior autologous SCT were included in a prospective multicenter trial to determine the efficacy of a reduced melphalan (140 mg/m2)/fludarabine regimen followed by allogeneic SCT from unrelated donors. GvHD prophylaxis consisted of anti-lymphocyte globulin (ATG-Fresenius®), cyclopsorin A and short course of MTX. Results: No primary or secondary graft failure was observed and all patients showed leukocyte and platelet engraftment after a median of 15 and 19 days, respectively. Acute graft-versus-host disease (GvHD) grade II to IV occurred in 25% and chronic GvHD in 35% of the patients. Limited GvHD was seen in 29 % and extensive GvHD was seen in 6 % of the patients. Overall response rate at day 100 was 95% including 46% complete remission (CR). Cumulative incidence (CI) of non-relapse mortality at one year was 25% (95% CI: 13-37%) and significantly lower for HLA matched compared to mismatched SCT (10% vs. 53%, p=0.001). During follow-up 22 patients experienced relapse (54 %) resulting in a cumulative incidence of relapse at 1, and 3 years of 27% (95% CI: 14-40%) and 55% (95% CI: 40-70%), respectively. The median time to relapse was 318 days (r: 56 – 861). After a median follow up of 43 months, the estimated 5-year progression-free (PFS) and overall survival (OS) rates were 20% and 26%, respectively and were significantly better for matched in CR at day 100 (41 vs. 7%, p=0.04 and 56 vs. 16%, p=0.02). Conclusions: Allogeneic stem cell transplantation from unrelated donors after a reduced intensity regimen is feasible, but an optimal donor selection is mandatory for a low non-relapse mortality. The high relapse incidence remains a major concern should be improved by including posttransplant strategies to upgrade remission status. Disclosures: No relevant conflicts of interest to declare.

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