Hematopoietic Stem Cell Transplantation From Haploidentical Donors in Aplasia After Cladribine/Cytarabine Chemotherapy for Refractory Acute Myeloid Leukemia or Myelodysplastic Syndrome |
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| Affiliation: | 1. Department of Gynaecology and Obstetrics, Tangshan Worker''s Hospital, Tangshan 063000, China;2. School of Biotechnology and State Key Laboratory of Bioreactor Engineering, East China University of Science and Technology, Shanghai 200237, China;3. School of Pharmacy and Shanghai Key Laboratory of New Drug Design, East China University of Science and Technology, Shanghai 200237, China;1. Thomas Jefferson University, Philadelphia, PA, USA;2. Department of Neurology and Institute of Experimental Neurology, University Vita-Salute IRCCS, San Raffaele Hospital, Milan, Italy;3. University of California, San Francisco, CA, USA;4. Stony Brook University Medical Center, Stony Brook, NY, USA;5. University of Ottawa and the Ottawa Hospital Research Institute, Ottawa, ON, Canada;6. Department of Neurology and Center for Neuropsychiatry, Medical Faculty, Heinrich-Heine University, Duesseldorf, Germany;7. University of Lille-Nord de France, Hôpital Roger Salengro, Lille, France |
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| Abstract: | IntroductionSurvival rate of patients with chemorefractory acute myeloid leukemia (AML) or myelodysplastic syndrome with excess blasts (MDS-EB) is poor. Allogeneic hematopoietic cell transplantation (HCT) is the only potentially curative therapy in these patients.Patients and MethodsWe report a retrospective analysis of outcomes of therapy of 24 patients with AML or MDS-EB refractory to high-dose salvage chemotherapy or who had failed previous HCT, who received T-cell–replete HLA haploidentical HCT in aplasia after cladribine/cytarabine-based chemotherapy followed by reduced intensity or myeloablative conditioning. All patients had active disease before commencement of the treatment.ResultsOf the patients, 91.7% achieved complete remission (CR), whereas 2 patients (8.2%) died in aplasia. One-year relapse rate was 49.3%. Cumulative incidence of nonrelapse mortality (NRM) was 25.6%. In a subgroup of patients with HCT–comorbidity index score ≤ 3, NRM was 15.4%. Two-year overall survival and relapse-free survival were 30.6% and 22.6%, respectively. Incidence of grade 3 and 4 acute graft versus host disease was 21.3% and 8.3, respectively.ConclusionWe found that sequential therapy with HCT in aplasia after cladribine/cytarabine chemotherapy is feasible, results in high CR rates, and has acceptable toxicity profile; however, posttransplant relapse is common in patients treated with active disease. |
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| Keywords: | Acute myeloid leukemia Chemotherapy Hematopoietic cell transplantation Myelodysplastic syndrome Refractory/relapsed |
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