BackgroundReduced intensity conditioning regimens permit the delivery of a potentially curative graft-versus-leukemia effect in older patients with acute myeloid leukemia. Although T-cell depletion is increasingly used to reduce the risk of graft-versus-host disease its impact on the graft-versusleukemia effect and long-term outcome post-transplant is unknown. Design and MethodsWe have characterized pre-and post-transplant factors determining overall survival in 168 patients with acute myeloid leukemia transplanted using an alemtuzumab based reduced intensity conditioning regimen with a median duration of follow-up of 37 months. ResultsThe 3-year overall survival for patients transplanted in CR1 or CR2/CR3 was 50% (95% CI, 38% to 62%) and 44% (95% CI, 31% to 56%), respectively compared to 15% (95% CI, 2% to 36%) for patients with relapsed/refractory disease. Multivariate analysis demonstrated that both survival and disease relapse were influenced by status at transplant (P=0.008) and presentation cytogenetics (P=0.01). Increased exposure to cyclosporine A (CsA) in the first 21 days post-transplant was associated with an increased relapse risk (P<0.0001) and decreased overall survival (P<0.0001). ConclusionsDisease stage, presentation karyotype and post-transplant CsA exposure are important predictors of outcome in patients undergoing a T-cell depleted reduced intensity conditioning allograft for acute myeloid leukemia. These data confirm the presence of a potent graft-versusleukemia effect after a T-cell depleted reduced intensity conditioning allograft in acute myeloid leukemia and identify CsA exposure as a manipulable determinant of outcome in this setting.Key words: reduced intensity conditioning, graft-versus-leukemia, acute myeloid leukemia. leukemia. Haematologica 2010;95:989-995. doi:10.3324/haematol.2009 This is an open-access paper. Citation: Craddock C, Nagra S, Peniket A, Brookes C, Buckley L, Nikolousis E, Duncan N, Tauro S, Yin J, Liakopoulou E, Kottaridis P, Snowden J, Milligan D, Cook G, Tholouli E, Littlewood T, Peggs K, Vyas P, Clark F, Cook M, MacKinnon S, and Russell N. Factors predicting long-term survival after T-cell depleted reduced intensity allogeneic stem cell transplantation for acute myeloid Factors predicting long-term survival after T-cell depleted reduced intensity allogeneic stem cell transplantation for acute myeloid leukemia

No abstract

Summary:Autoimmune haemolytic anaemia (AIHA), immune thrombocytopenia (ITP) and autoimmune neutropenia (AIN) are well-recognised complications of allogeneic stem cell transplantation (SCT), but have previously only been reported in the context of myeloablative conditioning regimens. Management of AIHA, ITP or AIN occurring after allogeneic SCT is unsatisfactory since they frequently prove refractory to conventional therapies including splenectomy. As a consequence, autoimmune cytopenias occurring after allogeneic SCT are associated with substantial morbidity and mortality. We report four patients who developed AIHA or ITP after allogeneic transplantation -three of which occurred after a reducedintensity conditioning (RIC) regimen. All patients demonstrated a complete response to Rituximab, having failed to respond to conventional treatment including high-dose prednisolone and intravenous immunoglobulin (IVIg). We conclude that Rituximab can be a valuable agent in the management of autoimmune cytopenias occurring after allogeneic SCT and that autoimmune cytopenias may be a hitherto unrecognised complication of RIC regimens.

Amphotericin B lipid complex represents a valuable therapeutic option in the treatment of fungal infections but improved strategies for the management of infusion-related adverse events are required.

Conflict of interest: COI declared -see note COI notes: V.M. received research grants from MSD/ Gilead and speakership from MSD, Gilead, Pfizer, Novartis, Jazz, Incyte. E.T. declares advisory boards for Celgene, Gilead/Kite, Jazz, Novartis, Pfizer and MSD, speaker fees for Gilead/Kite, Janssen, Jazz, Novartis and Pfizer and consultancy for educational materials for Gilead/Kite. A.P. declares advisory board for MSD. R.L. received educational grants and speaker fees for MSD, Chugai Pharma, Astellas, Gilead, Sanofi. E.N. declares advisory boards for Kite/Gilead, Novartis, BMS/Celgene, Pfizer and conference support for Kite/Gilead, Novartis and speaker fees for Kite/Gilead. J.A.S. declares honoraria for educational events supported by Jazz, Mallinckrodt, Gilead, Janssen, and Actelion, advisory board participation for Medac and IDMC membership for a Kiadis Pharma supported clinical trial, none of which are directly related to this study. E.H.