AML: new transplant protocol offers favorable survival, GVHD prophylaxis

  • Salas MQ & al.
  • Eur J Haematol
  • 26 Aug 2019

  • curated by David Reilly
  • Univadis Clinical Summaries
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

Takeaway

  • In patients with acute myeloid leukemia (AML), reduced-intensity conditioning (RIC) and subsequent allogeneic hematopoietic stem cell transplantation (allo-HSCT) combined with antithymocyte globulin (ATG) and posttransplant cyclophosphamide (PTCy) was potentially curative and delivered high-level graft-vs-host disease (GVHD)/relapse-free survival at 1 year.

Why this matters

  • Optimal conditioning and GVHD prophylaxis have yet to be established in this setting.

Study design

  • Study to investigate outcomes following RIC, subsequent allo-HSCT combined with ATG, then PTCy in 147 adult patients with AML.
  • Funding: None disclosed.

Key results

  • Cumulative incidence of GVHD at day +100:
    • Grade II-IV acute GVHD (aGVHD): 14.3% (95% CI, 2.3%-26.3%).
    • Grade III-IV aGVHD: 1.4% (95% CI, 0%-6.4%).
  • 8.3% (95% CI, 1.2%-15.4%) moderate and severe chronic GVHD (cGVHD) at 1 year.  
  • No significant difference in cumulative incidence by donor type for:
    • Grade II-IV aGVHD: P=.42.
    • Moderate-severe cGVHD: P=.463.
  • At 1 year:
    • 66.9% (95% CI, 58.4%-74%) OS.
    • 59.9% (95% CI, 51.3%-67.5%) relapse-free survival (RFS).
    • 21.4% (95% CI, 13.1%-29.6%) cumulative incidence of relapse.
    • 18.7% (95% CI, 10.8%-26.7%) nonrelapse mortality.
    • 53.7% (95% CI, 45.1%-61.5%) GVHD-free/RFS.

Limitations

  • Limited sample size.