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Wang L, Gao W, Wang L, Wan M, Jiang J, Hu J. Cladribine-based debulking chemotherapy sequential with reduced intensity regimen and post-transplantation maintenance for refractory myeloid leukemia: a prospective phase II clinical trial. Bone Marrow Transplant 2022; 57:1004-1006. [PMID: 35352037 DOI: 10.1038/s41409-022-01639-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 03/07/2022] [Accepted: 03/11/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Ling Wang
- Shanghai Institute of Hematology, Blood & Marrow Transplantation Center, Collaborative Innovation Center of Hematology, Department of Hematology, Rui Jin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenhui Gao
- Shanghai Institute of Hematology, Blood & Marrow Transplantation Center, Collaborative Innovation Center of Hematology, Department of Hematology, Rui Jin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lining Wang
- Shanghai Institute of Hematology, Blood & Marrow Transplantation Center, Collaborative Innovation Center of Hematology, Department of Hematology, Rui Jin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Min Wan
- Shanghai Clinical Research Center (SCRC), Feng Lin International Centre, Shanghai, China
| | - Jieling Jiang
- Shanghai Institute of Hematology, Blood & Marrow Transplantation Center, Collaborative Innovation Center of Hematology, Department of Hematology, Rui Jin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Jiong Hu
- Shanghai Institute of Hematology, Blood & Marrow Transplantation Center, Collaborative Innovation Center of Hematology, Department of Hematology, Rui Jin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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2
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Zhang XH, Chen J, Han MZ, Huang H, Jiang EL, Jiang M, Lai YR, Liu DH, Liu QF, Liu T, Ren HY, Song YP, Sun ZM, Tang XW, Wang JM, Wu DP, Xu LP, Zhang X, Zhou DB, Huang XJ. The consensus from The Chinese Society of Hematology on indications, conditioning regimens and donor selection for allogeneic hematopoietic stem cell transplantation: 2021 update. J Hematol Oncol 2021; 14:145. [PMID: 34526099 PMCID: PMC8441240 DOI: 10.1186/s13045-021-01159-2] [Citation(s) in RCA: 126] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 08/30/2021] [Indexed: 02/08/2023] Open
Abstract
The consensus recommendations in 2018 from The Chinese Society of Hematology (CSH) on indications, conditioning regimens and donor selection for allogeneic hematopoietic stem cell transplantation (allo-HSCT) facilitated the standardization of clinical practices of allo-HSCT in China and progressive integration with the world. There have been new developments since the initial publication. To integrate recent developments and further improve the consensus, a panel of experts from the CSH recently updated the consensus recommendations, which are summarized as follows: (1) there is a new algorithm for selecting appropriate donors for allo-HSCT candidates. Haploidentical donors (HIDs) are the preferred donor choice over matched sibling donors (MSDs) for patients with high-risk leukemia or elderly patients with young offspring donors in experienced centers. This replaces the previous algorithm for donor selection, which favored MSDs over HIDs. (2) Patients with refractory/relapsed lymphoblastic malignancies are now encouraged to undergo salvage treatment with novel immunotherapies prior to HSCT. (3) The consensus has been updated to reflect additional evidence for the application of allo-HSCT in specific groups of patients with hematological malignancies (intermediate-risk acute myeloid leukemia (AML), favorable-risk AML with positive minimal residual disease, and standard-risk acute lymphoblastic leukemia). (4) The consensus has been updated to reflect additional evidence for the application of HSCT in patients with nonmalignant diseases, such as severe aplastic anemia and inherited diseases. (5) The consensus has been updated to reflect additional evidence for the administration of anti-thymocyte globulin, granulocyte colony-stimulating factors and post-transplantation cyclophosphamide in HID-HSCT.
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Affiliation(s)
- Xiao-hui Zhang
- Peking University People’s Hospital, Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, National Clinical Research Center for Hematologic Disease, Beijing, China
| | - Jing Chen
- Shanghai Children’s Medical Center, Shanghai, China
| | - Ming-Zhe Han
- Institute of Hematology and Blood Disease Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Hematologic Disease, Tianjin, China
| | - He Huang
- First Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Er-lie Jiang
- Institute of Hematology and Blood Disease Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Hematologic Disease, Tianjin, China
| | - Ming Jiang
- The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Yong-rong Lai
- The First Affiliated Hospital of Guangxi Medical University, Guilin, China
| | - Dai-hong Liu
- General Hospital of PLA (People’s Liberation Army of China), Beijing, China
| | - Qi-Fa Liu
- Nanfang Hospital of Southern Medical University, Guangzhou, China
| | - Ting Liu
- West China Hospital, Sichuan University, Chengdu, China
| | - Han-yun Ren
- Peking University First Hospital, Beijing, China
| | - Yong-Ping Song
- Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Zi-min Sun
- The First Affiliated Hospital of University of Science and Technology of China, Hefei, China
| | - Xiao-wen Tang
- The First Affiliated Hospital of Soochow Hospital, National Clinical Research Center for Hematologic Disease, Suzhou, China
| | - Jian-min Wang
- Changhai Hospital of Shanghai, Naval Medical University, Shanghai, China
| | - De-pei Wu
- The First Affiliated Hospital of Soochow Hospital, National Clinical Research Center for Hematologic Disease, Suzhou, China
| | - Lan-ping Xu
- Peking University People’s Hospital, Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, National Clinical Research Center for Hematologic Disease, Beijing, China
| | - Xi Zhang
- Xinqiao Hospital, Army Military Medical University, Chongqing, China
| | - Dao-bin Zhou
- Peking Union Medical College Hospital, Beijing, China
| | - Xiao-jun Huang
- Peking University People’s Hospital, Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, National Clinical Research Center for Hematologic Disease, Beijing, China
- Peking-Tsinghua Center for Life Sciences, Beijing, China
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3
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Tao S, Song L, Deng Y, Chen Y, Gan Y, Li Y, Ding Y, Zhang Z, Ding B, He Z, Wang C, Yu L. Successful treatment of two relapsed patients with t(11;19)(q23;p13) acute myeloid leukemia by CLAE chemotherapy sequential with allogeneic hematopoietic stem cell transplantation: Case reports. Oncol Lett 2021; 21:178. [PMID: 33574917 PMCID: PMC7816337 DOI: 10.3892/ol.2021.12439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 11/20/2020] [Indexed: 12/26/2022] Open
Abstract
The prognosis of patients with relapsed/refractory acute myeloid leukemia (R/R AML) is poor, with a 3-year overall survival rate of 10%. Patients with translocation (t)(11;19)(q23;p13) have a higher risk of relapse and there is no optimal regimen for these patients. The present study treated two young patients with t(11;19)(q23;p13) AML, who relapsed after one or two cycles of consolidation, with a salvage treatment consisting of sequential cladribine, cytarabine and etoposide (CLAE) and allogeneic hematopoietic stem cell transplantation (allo-HSCT). Both neutrophil and platelet engraftments were achieved within 15 days, and no severe transplant-related complications and graft-versus-host diseases were observed. Following allo-HSCT, both patients achieved complete hematologic and cytogenetic remission. Decitabine was used for the prophylaxis of relapse. The two patients remained alive and disease-free for 100 days following allo-HSCT. The results presented here suggest that CLAE regimen sequential with allo-HSCT may be effective in treating patients with R/R AML, with t(11;19)(q23;p13). However, further studies and a larger sample size are required to validate the effectiveness of this treatment regimen.
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Affiliation(s)
- Shandong Tao
- Department of Hematology, The Affiliated Huai'an No. 1 People's Hospital of Nanjing Medical University, Huai'an, Jiangsu 223300, P.R. China.,Key Laboratory of Hematology, Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Lixiao Song
- Department of Hematology, The Affiliated Huai'an No. 1 People's Hospital of Nanjing Medical University, Huai'an, Jiangsu 223300, P.R. China.,Key Laboratory of Hematology, Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Yuan Deng
- Department of Hematology, The Affiliated Huai'an No. 1 People's Hospital of Nanjing Medical University, Huai'an, Jiangsu 223300, P.R. China.,Key Laboratory of Hematology, Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Yue Chen
- Department of Hematology, The Affiliated Huai'an No. 1 People's Hospital of Nanjing Medical University, Huai'an, Jiangsu 223300, P.R. China.,Key Laboratory of Hematology, Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Yimin Gan
- Department of Hematology, The Affiliated Huai'an No. 1 People's Hospital of Nanjing Medical University, Huai'an, Jiangsu 223300, P.R. China.,Key Laboratory of Hematology, Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Yunjie Li
- Department of Hematology, The Affiliated Huai'an No. 1 People's Hospital of Nanjing Medical University, Huai'an, Jiangsu 223300, P.R. China.,Key Laboratory of Hematology, Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Yihan Ding
- Department of Hematology, The Affiliated Huai'an No. 1 People's Hospital of Nanjing Medical University, Huai'an, Jiangsu 223300, P.R. China.,Key Laboratory of Hematology, Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Zhe Zhang
- Department of Hematology, The Affiliated Huai'an No. 1 People's Hospital of Nanjing Medical University, Huai'an, Jiangsu 223300, P.R. China.,Key Laboratory of Hematology, Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Banghe Ding
- Department of Hematology, The Affiliated Huai'an No. 1 People's Hospital of Nanjing Medical University, Huai'an, Jiangsu 223300, P.R. China.,Key Laboratory of Hematology, Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Zhengmei He
- Department of Hematology, The Affiliated Huai'an No. 1 People's Hospital of Nanjing Medical University, Huai'an, Jiangsu 223300, P.R. China.,Key Laboratory of Hematology, Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Chunling Wang
- Department of Hematology, The Affiliated Huai'an No. 1 People's Hospital of Nanjing Medical University, Huai'an, Jiangsu 223300, P.R. China.,Key Laboratory of Hematology, Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Liang Yu
- Department of Hematology, The Affiliated Huai'an No. 1 People's Hospital of Nanjing Medical University, Huai'an, Jiangsu 223300, P.R. China.,Key Laboratory of Hematology, Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
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4
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Heinicke T, Labopin M, Polge E, Stelljes M, Ganser A, Tischer J, Brecht A, Kröger N, Beelen DW, Scheid C, Bethge W, Dreger P, Bunjes D, Wagner E, Platzbecker U, Savani BN, Nagler A, Mohty M. Evaluation of six different types of sequential conditioning regimens for allogeneic stem cell transplantation in relapsed/refractory acute myelogenous leukemia - a study of the Acute Leukemia Working Party of the EBMT. Leuk Lymphoma 2020; 62:399-409. [PMID: 33040622 DOI: 10.1080/10428194.2020.1827248] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The Acute Leukemia Working Party (ALWP) of the EBMT assessed the outcome of allogeneic stem cell transplantation (alloSCT) in patients with relapsed/refractory AML (r/rAML) evaluating six sequential conditioning regimens (SR) groups. A total of 2132 patients were included. LFS at 2 years was 28.9%, 33.6%, 35.3%, 20.6%, 24.4%, and 27% for the FLAMSA-TBI4, FLAMSA-Chemo, Mel-Flu-TBI8, Mel-Treo-Flu, Thio-ETO-Cy-Bu2-Flu, and Clo-ARAC-(Bu2/TBI4)-Cy groups, respectively. In patients <55 years of age Mel-Flu-TBI8 had the best LFS, which was statistically significant only in comparison to the Mel-Treo-Flu group, while in patients ≥55 years LFS was best with FLAMSA-Chemo without significant differences compared to FLAMSA-TBI4 and Mel-Flu-TBI8. Furthermore, best NRM rates were obtained with the two FLAMSA regimens groups. Our study suggests that in younger (<55 years) patients a more intense regimen might be used whereas in older (≥55 years) patients the focus might be more on tolerability.
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Affiliation(s)
- Thomas Heinicke
- Department of Hematology and Oncology, Otto-von-Guericke University, Magdeburg, Germany
| | - Myriam Labopin
- Department of Hematology and Cell Therapy, Hopital Saint-Antoine, Paris, France.,Acute Leukemia Working Party of EBMT Office, Hopital St. Antoine, Paris, France
| | - Emmanuelle Polge
- Acute Leukemia Working Party of EBMT Office, Hopital St. Antoine, Paris, France
| | - Matthias Stelljes
- Department of Internal Medicine A, University of Muenster, Muenster, Germany
| | - Arnold Ganser
- Department of Haematology, Hemostasis, Oncology, Hannover Medical School, Hannover, Germany
| | - Johanna Tischer
- Department of Internal Medicine III, Hematopoietic Stem Cell Transplantation, University Hospital of Munich-Campus Grosshadern, LMU, Munich, Germany
| | - Arne Brecht
- DKD Helios-Klinikum, KMT-Abteilung, Wiesbaden, Germany
| | - Nicolaus Kröger
- Department of Stem Cell Transplantation, University Hospital Eppendorf, Hamburg, Germany
| | - Dietrich W Beelen
- Department of Bone Marrow Transplantation, University Hospital Essen, Essen, Germany
| | - Christof Scheid
- I Department of Medicine, University of Cologne, Cologne, Germany
| | - Wolfgang Bethge
- Medizinische Klinik II, University Tübingen, Tübingen, Germany
| | - Peter Dreger
- Medizinische Klinik u. Poliklinik V, University of Heidelberg, Heidelberg, Germany
| | - Donald Bunjes
- Klinik fuer Innere Medzin III, University Hospital Ulm, Ulm, Germany
| | - Eva Wagner
- Department of Hematology, Oncology and Pneumology, University Medical Center Mainz, Mainz, Germany
| | - Uwe Platzbecker
- Medical Clinic and Policlinic 1, University Hospital Leipzig, Leipzig, Germany
| | - Bipin N Savani
- Division of Hematology-Oncology, Vanderbilt University Medical Center, Brentwood, TN, USA
| | - Arnon Nagler
- Acute Leukemia Working Party of EBMT Office, Hopital St. Antoine, Paris, France.,Hematology Division and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel-Hashomer and Tel Aviv University, Tel HaShomer, Israel
| | - Mohamad Mohty
- Department of Hematology and Cell Therapy, Hopital Saint-Antoine, Paris, France.,Acute Leukemia Working Party of EBMT Office, Hopital St. Antoine, Paris, France
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5
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Shargian-Alon L, Wolach O, Rozovski U, Yahav D, Sela-Navon M, Rubinstein M, Oniashvilli N, Pasvolsky O, Raanani P, Yeshurun M. Sequential treatment with FLAG-IDA/treosulfan conditioning regimen for patients with active acute myeloid leukemia. Ann Hematol 2020; 99:2939-2945. [PMID: 32892274 DOI: 10.1007/s00277-020-04232-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 08/24/2020] [Indexed: 10/23/2022]
Abstract
Sequential protocols combining salvage chemotherapy with reduced intensity conditioning (RIC) and allogeneic hematopoietic cell transplantation (alloHCT) for high-risk acute myeloid leukemia (AML) have been studied more than a decade. Purpose of this retrospective analysis was to evaluate the anti-leukemic efficacy and toxicity of FLAG-IDA protocol (fludarabine, cytarabine, and idarubicin) followed by treosulfan-based conditioning for patients with active AML. From January 2014 to November 2019, a total of 29 active AML patients [median age, 64 years (range, 23-73)] were treated. All patients completed protocol regimen and were transplanted. Five patients (17%) had grade 3-4 toxicities; therefore, treosulfan was substituted with total body irradiation (TBI) non-myeloablative conditioning. Six (20%) patients died within 30 post-transplant days, all from infectious complications. Out of 23 evaluable patients on day 30, 22 (96%) achieved complete hematologic remission with full donor chimerism. Non-relapse mortality (NRM) rates at 1 and 3 years were 22% and 49%, respectively. Median overall survival (OS) was 12 (95% CI, 4-20) months. OS and disease-free survival were 50% and 46% at 1 year and 28% and 17% at 2 years, respectively. Age, gender, disease burden, number of previous lines, and comorbidity score did not predict survival. Sequential strategy combining FLAG-IDA and treosulfan may offer a salvage option for few selected patients with active AML; however, high NRM presents a major obstacle to treatment success. Future efforts should focus on reducing NRM by moderating regimen intensity and by better selection of patients.
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Affiliation(s)
- Liat Shargian-Alon
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital, 49100, Petah-Tikva, Israel. .,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Ofir Wolach
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital, 49100, Petah-Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Uri Rozovski
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital, 49100, Petah-Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dafna Yahav
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Infectious Disease Unit, Rabin Medical Center, Petah-Tikva, Israel
| | - Michal Sela-Navon
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital, 49100, Petah-Tikva, Israel
| | - Mazal Rubinstein
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital, 49100, Petah-Tikva, Israel
| | - Nino Oniashvilli
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Raphael Recanati Genetic Institute, Rabin Medical Center, Petah-Tikva, Israel
| | - Oren Pasvolsky
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital, 49100, Petah-Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Pia Raanani
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital, 49100, Petah-Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Moshe Yeshurun
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital, 49100, Petah-Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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