Journal
BONE MARROW TRANSPLANTATION
Volume 57, Issue 8, Pages 1304-1312Publisher
SPRINGERNATURE
DOI: 10.1038/s41409-022-01703-9
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Funding
- Fondo de Investigaciones Sanitarias/Instituto deSalud Carlos III (ISCIII) [PI16/01027, PI19/1476, PI20/01621]
- PERIS from Generalitat de Catalunya [SLT002/16/00433, SGR 1395, SGR 1655]
- Premi Fi de Residencia de la Societat Catalana d'Hematologia i Hemoterapia per a la Investigacio en Hematologia 2019
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This study analyzed the long-term outcomes of a sequential regimen based on IDA-FLAG and high-dose melphalan in patients with relapsed/refractory acute myeloid leukemia. The results showed that this regimen achieved a high complete response rate and a lower cumulative relapse incidence, but also had a high non-relapse mortality and a significant incidence of grade 3-4 acute graft-versus-host disease. Long-term survivors enjoyed a good quality of life.
Allogeneic hematopoietic cell transplantation (alloHCT) remains the only curative option for relapsed/refractory acute myeloid leukemia and other high-risk myeloid malignancies. To improve alloHCT results in this setting, sequential regimens were designed as a strategy to lower tumor burden and quickly induce the graft-versus-leukemia effect. We analyzed long-term outcomes of a sequential regimen based on IDA-FLAG and high-dose melphalan, as set forth by the CETLAM cooperative group. This protocol yielded a high complete response rate (89%) and a lower cumulative relapse incidence (30% at five years) compared to other regimens. Five-year non-relapse mortality, however, reached 45%, with grade 3-4 acute graft-versus-host disease being the most frequent adverse event (a 100-day incidence of 29%). Altogether, 5-year overall survival was 25% in this group of patients with otherwise dismal prognosis. Long-term survivors enjoyed a good quality of life after a median follow-up of 68 months.
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