Improved survival of AML patients by addition of cladribine to standard induction chemotherapy
ANNALS OF HEMATOLOGY
Authors: Anzej Doma, Sasa; Skerget, Matevz; Pajic, Tadej; Sever, Matjaz
One hundred and eight consecutive acute myeloid leukemia (AML) patients aged 60 or less treated with two different induction regimens were retrospectively analyzed. Induction regimen for the first 50 consecutive patients was DA3+7, and the following 58 patients received cladribine 5 mg/m(2) on days 1 through 5 in addition to DA3+7 (DAC). There were no significant differences in the median age and the proportion of patients with unfavorable characteristics between the two groups. Remission after induction chemotherapy was achieved in 30/50 (60%) patients in DA3+7 and in 46/58 (79%) in DAC group (p = 0.028). The median survival in the DA3+7 group was 18 months, while in the DAC group it was not reached (p = 0.034). We confirmed results from other research groups by demonstrating improved remission induction rate and overall survival of AML patients aged 60 years or less treated with DAC induction compared with standard DA3+7 induction chemotherapy.
Clinical practice recommendation on hematopoietic stem cell transplantation for acute myeloid leukemia patients with FLT3-internal tandem duplication: a position statement from the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation
Authors: Bazarbachi, Ali; Bug, Gesine; Baron, Frederic; Brissot, Eolia; Ciceri, Fabio; Abou Dalle, Iman; Dohner, Hartmut; Esteve, Jordi; Floisand, Yngvar; Giebel, Sebastian; Gilleece, Maria; Gorin, Norbert-Claude; Jabbour, Elias; Aljurf, Mahmoud; Kantarjian, Hagop; Kharfan-Dabaja, Mohamed; Labopin, Myriam; Lanza, Francesco; Malard, Florent; Peric, Zinaida; Prebet, Thomas; Ravandi, Farhad; Ruggeri, Annalisa; Sanz, Jaime; Schmid, Christoph; Shouval, Roni; Spyridonidis, Alexandros; Versluis, Jurjen; Vey, Norbert; Savani, Bipin N.; Nagler, Arnon; Mohty, Mohamad
The FMS-like tyrosine kinase 3 (FLT3) gene is mutated in 25-30% of patients with acute myeloid leukemia (AML). Because of the poor prognosis associated with FLT3-internal tandem duplication mutated AML, allogeneic hematopoietic stem-cell transplantation (SCT) was commonly performed in first complete remission. Remarkable progress has been made in frontline treatments with the incorporation of FLT3 inhibitors and the development of highly sensitive minimal/measurable residual disease assays. Similarly, recent progress in allogeneic hematopoietic SCT includes improvement of transplant techniques, the use of haploidentical donors in patients lacking an HLA matched donor, and the introduction of FLT3 inhibitors as post-transplant maintenance therapy. Nevertheless, current transplant strategies vary between centers and differ in terms of transplant indications based on the internal tandem duplication allelic ratio and concomitant nucleophos-min-1 mutation, as well as in terms of post-transplant maintenance/consolidation. This review generated by international leukemia or transplant experts, mostly from the European Society for Blood and Marrow Transplantation, attempts to develop a position statement on best approaches for allogeneic hematopoietic SCT for AML with FLT3-internal tandem duplication including indications for and modalities of such transplants and on the potential optimization of post-transplant maintenance with FLT inhibitors.