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
Fiche publication
Date publication
juin 2020
Journal
Annals of hematology
Auteurs
Membres identifiés du Cancéropôle Est :
Dr BILGER Karin, Pr RUBIO Marie Thérèse
Tous les auteurs :
Le Bourgeois A, Labopin M, Marçais A, de Latour RP, Blaise D, Chantepie S, N'Guyen S, Maillard N, Forcade E, Yakoub-Agha I, Huynh A, Marchand T, Bilger K, Ceballos P, Charbonnier A, Turlure P, Rubio MT, Béné MC, Guillaume T, Mohty M, Chevallier P,
Lien Pubmed
Résumé
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/day) and cytosine arabinoside (1 g/m/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.
Mots clés
Acute myeloid leukemia, Allogeneic stem cell transplantation, Clofarabine, Reduced intensity conditioning regimen, Sequential regimen
Référence
Ann. Hematol.. 2020 Jun 20;: