Comparative outcomes of myeloablative and reduced‐intensity conditioning allogeneic hematopoietic cell transplantation for therapy‐related acute myeloid leukemia with prior solid tumor: A report from the acute leukemia working party of the European society for blood and bone marrow transplantation

Abstract

Therapy‐related acute myeloid leukemia (t‐AML) arises as a late complication following antecedent solid tumors or hematologic diseases and their associated treatments. There are limited data regarding risk factors and outcomes following allogeneic hematopoietic cell transplantation (HCT) for t‐AML following a prior solid tumor, and furthermore, the impact of myeloablative (MAC) vs reduced‐intensity conditioning (RIC) on survival is unknown. The acute leukemia working party (ALWP) of the European society for blood and bone marrow transplantation (EBMT) performed a large registry study that included 535 patients with t‐AML and prior solid tumor who underwent first MAC or RIC allogeneic HCT from 2000‐2016. The primary endpoints of the study were OS and LFS. Patients receiving RIC regimens had an increase in relapse incidence (hazard ratio [HR], 1.52; 95% confidence interval [CI] 1.02‐2.26; P = 0.04), lower LFS (HR, 1.52; 95% CI 1.12‐2.05, P = 0.007), and OS (HR, 1.51; CI 1.09‐2.09; P = 0.012). There were no differences in NRM and GRFS. Importantly, LFS and OS were superior in patients receiving ablative regimens due to a decrease in relapse. As NRM continues to decline in the current era, it is conceivable that outcomes of HCT for t‐AML with prior solid tumor may be improved by careful patient selection for myeloablative regimens.

Clofarabine and Treosulfan as Conditioning for Matched Related and Unrelated Hematopoietic Stem Cell Transplantation: Results from the Clo3o Phase II Trial

“…In our study, clofarabine and treosulfan were associated with a low incidence of severe hepatic toxicities, such as VOD. The NRM was 18% at 1 year, comparable to that reported for other myeloablative conditioning regimens in high-risk populations [35]. Although in line with our primary endpoint, recently a lower incidence of NRM was reported for patients in CR using a combination of busulfan and fludarabine [25].…”

Inferior outcome of allogeneic stem cell transplantation for secondary acute myeloid leukemia in first complete remission as compared to de novo acute myeloid leukemia

“…Furthermore, the results may contribute to the design of optimized transplant protocols. Previous studies have suggested comparable outcomes after RIC and MAC in sAML, however, with a trend for better outcome after MAC 11,29 . Hence, a myeloablative, but reduced toxicity conditioning regimen such as the combination of Fludarabine and Treosulfan 30 might be of particular value in patients with sAML.…”

ELN risk stratification and outcomes in secondary and therapy-related AML patients consolidated with allogeneic stem cell transplantation

“…As a consequence of the low cure rates of not more than 20% after chemotherapy alone [8,9], allogeneic HSCT often is the preferred consolidation option in s/tAML patients. Here, mostly registrybased data not including de novo AML individuals suggest allogeneic HSCT as a suitable and often curative treatment option for s/tAML patients [13][14][15][16][17][18]. However, data comparing outcomes of s/tAML and de novo AML patients undergoing allogeneic HSCT remain sparse.…”