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Eggimann M, Akhoundova D, Nilius H, Hoffmann M, Hayoz M, Aebi Y, Largiadèr CR, Daskalakis M, Bacher U, Pabst T. Safety and Efficacy of High-Dose Chemotherapy with TreoMel 200 vs. TreoMel 140 in Acute Myeloid Leukemia Patients Undergoing Autologous Stem Cell Transplantation. Cancers (Basel) 2024; 16:1887. [PMID: 38791965 PMCID: PMC11120452 DOI: 10.3390/cancers16101887] [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: 02/08/2024] [Revised: 04/25/2024] [Accepted: 05/13/2024] [Indexed: 05/26/2024] Open
Abstract
(1) Background: Treosulfan and melphalan (TreoMel)-based high-dose chemotherapy (HDCT) has shown promising safety and efficacy as a conditioning regimen for acute myeloid leukemia (AML) patients undergoing autologous stem cell transplantation (ASCT). However, despite intensive first-line induction treatment and upfront consolidation with HDCT and ASCT, AML relapse rates are still high, and further efforts are needed to improve patient outcomes. The aim of this study was to compare two melphalan dose schedules in regard to the safety of TreoMel HDCT and patient outcomes. (2) Methods: We retrospectively analyzed the safety and efficacy of two melphalan dose schedules combined with standard-dose treosulfan in AML patients undergoing HDCT and ASCT at the University Hospital of Bern, Switzerland, between August 2019 and August 2023. Patients received treosulfan 42 g/m2 combined with either melphalan 140 mg/m2 (TreoMel 140) or melphalan 200 mg/m2 (TreoMel 200). Co-primary endpoints were progression-free survival (PFS), overall survival (OS), as well as safety profile. (3) Results: We included a total of 51 AML patients: 31 (60.8%) received TreoMel 140 and 20 (39.2%) TreoMel 200. The patients' basal characteristics were comparable between both cohorts. No significant differences in the duration of hospitalization or the adverse event profile were identified. There were no statistically significant differences in relapse (0.45 vs. 0.30, p = 0.381) and mortality rates (0.42 vs. 0.15, p = 0.064) between the melphalan 140 mg/m2 and 200 mg/m2 cohorts, nor for PFS (HR: 0.81, 95% CI: 0.29-2.28, p = 0.70) or OS (HR: 0.70, 95% CI: 0.19-2.57, p = 0.59) for the TreoMel 140 vs. TreoMel 200 cohort. (4) Conclusions: A higher dose of melphalan (TreoMel 200) was well tolerated overall. No statistically significant differences for patient outcomes could be observed, possibly due to the relatively small patient cohort and the short follow-up. A longer follow-up and prospective randomized studies would be required to confirm the safety profile and clinical benefit.
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Affiliation(s)
- Matthias Eggimann
- Department of Medical Oncology, Inselspital—Bern University Hospital, 3010 Bern, Switzerland; (M.E.); (D.A.); (M.H.)
| | - Dilara Akhoundova
- Department of Medical Oncology, Inselspital—Bern University Hospital, 3010 Bern, Switzerland; (M.E.); (D.A.); (M.H.)
| | - Henning Nilius
- Department of Clinical Chemistry, Inselspital—Bern University Hospital, 3010 Bern, Switzerland; (H.N.); (M.H.); (Y.A.); (C.R.L.)
| | - Michèle Hoffmann
- Department of Medical Oncology, Inselspital—Bern University Hospital, 3010 Bern, Switzerland; (M.E.); (D.A.); (M.H.)
| | - Michael Hayoz
- Department of Clinical Chemistry, Inselspital—Bern University Hospital, 3010 Bern, Switzerland; (H.N.); (M.H.); (Y.A.); (C.R.L.)
- Central Hematology Laboratory, Department of Hematology, Inselspital—Bern University Hospital, University of Bern, 3012 Bern, Switzerland; (M.D.); (U.B.)
| | - Yolanda Aebi
- Department of Clinical Chemistry, Inselspital—Bern University Hospital, 3010 Bern, Switzerland; (H.N.); (M.H.); (Y.A.); (C.R.L.)
- Central Hematology Laboratory, Department of Hematology, Inselspital—Bern University Hospital, University of Bern, 3012 Bern, Switzerland; (M.D.); (U.B.)
| | - Carlo R. Largiadèr
- Department of Clinical Chemistry, Inselspital—Bern University Hospital, 3010 Bern, Switzerland; (H.N.); (M.H.); (Y.A.); (C.R.L.)
- Central Hematology Laboratory, Department of Hematology, Inselspital—Bern University Hospital, University of Bern, 3012 Bern, Switzerland; (M.D.); (U.B.)
| | - Michael Daskalakis
- Central Hematology Laboratory, Department of Hematology, Inselspital—Bern University Hospital, University of Bern, 3012 Bern, Switzerland; (M.D.); (U.B.)
| | - Ulrike Bacher
- Central Hematology Laboratory, Department of Hematology, Inselspital—Bern University Hospital, University of Bern, 3012 Bern, Switzerland; (M.D.); (U.B.)
| | - Thomas Pabst
- Department of Medical Oncology, Inselspital—Bern University Hospital, 3010 Bern, Switzerland; (M.E.); (D.A.); (M.H.)
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Effect of the Thiotepa Dose in the TBF Conditioning Regimen in Patients Undergoing Allogeneic Stem Cell Transplantation for Acute Myeloid Leukemia in Complete Remission: A Report From the EBMT Acute Leukemia Working Party. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2020; 20:296-304. [PMID: 32081702 DOI: 10.1016/j.clml.2020.01.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 01/13/2020] [Accepted: 01/17/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND Allogeneic stem cell transplantation is a potentially curative therapy for patients with acute myeloid leukemia (AML) after achieving complete remission (CR). The aim of this study is to evaluate the optimal dose of thiotepa, administered as part of the thiotepa-busulfan-fludarabine (TBF) conditioning regimen for allogeneic stem cell transplantation in adults with AML in CR. PATIENTS AND METHODS In a retrospective multicenter analysis, we identified 240 patients allotransplanted from matched related or unrelated donors or T replete haplo-identical donors. We compared the transplantation outcomes of patients who received 5 mg/kg thiotepa and 2 days of intravenous busulfan at 6.4 mg/kg (T1B2F) versus those who received 10 mg/kg thiotepa with 2 days of intravenous busulfan at 6.4 mg/kg (T2B2F). The median follow-up was 20 months. RESULTS On univariate analysis, the incidence of acute graft versus host disease (GVHD) grade II to IV was significantly lower in the T1B2F group (19%) versus 32% in the T2B2F group (P = .029). This result was confirmed on multivariate analysis; acute GVHD was higher for patients receiving T2B2F (hazard ratio, 2.22; P = .024). No significant change in non-relapse mortality, progression-free survival, or overall survival was observed between the 2 groups. CONCLUSION T2B2F is associated with a higher incidence of acute GVHD compared with T1B2F. These results suggest that a lower dose-intensity of thiotepa and busulfan in the TBF regimen may yield better results in patients with AML in CR.
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