Long-term outcomes in patients with relapsed/refractory acute myeloid leukemia and other high-risk myeloid malignancies after undergoing sequential conditioning regimen based on IDA-FLAG and high-dose melphalan

Bone Marrow Transplant. 2022 Aug;57(8):1304-1312. doi: 10.1038/s41409-022-01703-9. Epub 2022 May 28.

Abstract

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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Disease-Free Survival
  • Graft vs Host Disease* / etiology
  • Hematopoietic Stem Cell Transplantation* / methods
  • Humans
  • Leukemia, Myeloid, Acute* / complications
  • Melphalan / therapeutic use
  • Myeloproliferative Disorders*
  • Quality of Life
  • Recurrence
  • Retrospective Studies
  • Transplantation Conditioning / methods

Substances

  • Melphalan