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Journal of Cancer Research and Clinical Oncology

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Open Access 21-10-2021 | Myelodysplastic Syndrome | Original Article – Clinical Oncology

Combination of treosulfan, fludarabine and cytarabine as conditioning in patients with acute myeloid leukemia, myelodysplastic syndrome and myeloproliferative neoplasms

Authors: Samantha O‘Hagan Henderson, Jochen J. Frietsch, Inken Hilgendorf, Andreas Hochhaus, Claus-Henning Köhne, Jochen Casper

Published in: Journal of Cancer Research and Clinical Oncology | Issue 10/2022

Abstract

Purpose

Treosulfan and fludarabine (Treo/Flu) were successfully introduced into toxicity-reduced conditioning for SCT. However, the risk of post-SCT relapse remains a matter of concern. We report the results of a novel individual treatment approach with Treo/Flu and cytarabine (Treo/Flu/AraC) conditioning prior to allogeneic SCT in patients with acute myeloid leukemia (AML), myelodysplastic syndrome (MDS), or myeloproliferative neoplasms (MPN).

Methods

Seventy-seven patients (median age 54 years) at high risk of disease relapse due to unfavorable cytogenetics or failure to achieve complete remission prior to SCT were included. Median follow-up was 3.2 years.

Results

The 1-, 2- and 3-year RFS rates were 49.4%, 41.7%, and 37.6% and OS rates were 59.3%, 49.3%, and 45.4%, respectively. Cumulative incidence of NRM was 10% at 100 days, 18.8% at 1 year and 20.1% at 2 years. The cumulative incidence of relapse increased from 31% at 1 year to 38.5% after 3 years. The cumulative incidences of engraftment, chimerism, graft-versus-host disease (GvHD) and toxicities were acceptable and comparable with similar patients conditioned with Treo/Flu or FLAMSA-RIC.

Conclusion

In conclusion, Treo/Flu/AraC provides tolerable, feasible, and effective conditioning for patients with AML, MDS or MPN, even in advanced disease states. The incidence of NRM and relapse is acceptable in this heavily pre-treated population with high-risk disease. Future research will aim to confirm these initial findings and include a larger number of participants in a prospective trial.

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Title: Combination of treosulfan, fludarabine and cytarabine as conditioning in patients with acute myeloid leukemia, myelodysplastic syndrome and myeloproliferative neoplasms
Authors: Samantha O‘Hagan Henderson
Jochen J. Frietsch
Inken Hilgendorf
Andreas Hochhaus
Claus-Henning Köhne
Jochen Casper
Publication date: 21-10-2021
Publisher: Springer Berlin Heidelberg
Keywords: Myelodysplastic Syndrome
Acute Myeloid Leukemia
Graft-Versus-Host Disease
Graft-Versus-Host Disease
Published in: Journal of Cancer Research and Clinical Oncology / Issue 10/2022
Print ISSN: 0171-5216
Electronic ISSN: 1432-1335
DOI: https://doi.org/10.1007/s00432-021-03836-8

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