Clinical Hematology International

Volume 1, Issue 1, March 2019, Pages 58 - 74

Allogeneic Stem Cell Transplantation for FLT3-Mutated Acute Myeloid Leukemia: In vivo T-Cell Depletion and Posttransplant Sorafenib Maintenance Improve Survival. A Retrospective Acute Leukemia Working Party-European Society for Blood and Marrow Transplant Study

Authors
Ali Bazarbachi1, 2, *, Myriam Labopin3, Giorgia Battipaglia4, 5, Azedine Djabali3, Edouard Forcade6, William Arcese7, Gerard Socié8, Didier Blaise9, Joerg Halter10, Sabine Gerull10, Jan J. Cornelissen11, Patrice Chevallier12, Johan Maertens13, Nicolaas Schaap14, Jean El-Cheikh1, Jordi Esteve15, Arnon Nagler16, Mohamad Mohty4, 5, *
1Bone Marrow Transplantation Program, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
2Department of Anatomy, Cell Biology, and Physiological Sciences, American University of Beirut, Beirut, Lebanon
3Acute Leukemia Working Party of EBMT, Paris, France
4Department of hematology and cellular therapy Hopital Saint Antoine, Paris, France.
5Department of hematology and cellular therapy, Hopital Saint Antoine, Université Pierre & Marie Curie, INSERM, UMRs 938, Paris, France
6Department of Hematology, CHU Bordeaux Hôpital Haut-leveque, Pessac, France
7Department of Stem cell transplant, Tor Vergata University of Rome, Rome, Italy
8Department of Hematology-bone marrow transplant, Hopital Saint Louis, Paris, France
9Department of Hematology, programme de Transplantation & Therapie Cellulaire, Centre de Recherche en Cancérologie de Marseille, Institut Paoli Calmettes, Marseille, France
10Department of Hematology, University Hospital Basel, Basel, Switzerland
11Department of Hematology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, Netherlands
12Department of Hematology, CHU Nantes, Nantes, France
13Department of Hematology, University Hospital Gasthuisberg, Leuven, Belgium
14Department of Hematology, Nijmegen Medical Centre, Nijmegen, Netherlands
15Hematology Department, IDIBAPS, Hospital Clinic, Barcelona, Spain
16Department of Hematology, Chaim Sheba Medical Center, Tel-Hashomer, Israel

Peer review is under the responsibility of IACH

*Corresponding authors. Email: bazarbac@aub.edu.lb; mohamad.mohty@inserm.fr
Corresponding Authors
Ali Bazarbachi, Mohamad Mohty
Received 8 February 2019, Accepted 20 February 2019, Available Online 18 March 2019.
DOI
https://doi.org/10.2991/chi.d.190310.001How to use a DOI?
Keywords
Allogeneic stem cell transplantation; Acute myeloid leukemia; FLT3 mutation; In vivo T-cell depletion; Sorafenib
Abstract

Acute myeloid leukemia (AML) with FLT3-mutation carries a poor prognosis, and allogeneic stem cell transplantation (allo-SCT) is recommended at first complete remission (CR1). We assessed 462 adults (median age 50 years) with FLT3-mutated AML allografted between 2010 and 2015 from a matched related (40%), unrelated (49%), or haploidentical donor (11%). The median follow-up of alive patients was 39 months. Day-100 acute graft versus host disease (GVHD) grades II–IV and III–IV were encountered in 26% and 9%, whereas the 2-year incidence of chronic and extensive chronic GVHD were 34% and 16%, respectively. The 2-year incidences of relapse and nonrelapse mortality were 34% and 15%, respectively. The 2-year leukemia-free survival, overall survival (OS), and GVHD relapse-free survival (GRFS) were 51%, 59%, and 38%, respectively. In multivariate analysis, NPM1-mutation, transplantation in CR1, in vivo T-cell depletion, and posttransplant sorafenib improved OS, whereas more than one induction (late CR1) negatively affected OS. Similarly, NPM1-mutation, a haploidentical donor, T-cell depletion, and sorafenib maintenance improved GRFS, whereas late CR1 or persistent disease negatively affected it. In conclusion, FLT3-mutated AML remains a challenge even following allo-SCT. In vivo T-cell depletion and posttransplant sorafenib significantly improve OS and GRFS, and may be considered as standard of care.

Copyright
© 2019 International Academy for Clinical Hematology. Publishing services by Atlantis Press International B.V.
Open Access
This is an open access article distributed under the CC BY-NC 4.0 license (http://creativecommons.org/licenses/by-nc/4.0/).

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Journal
Clinical Hematology International
Volume-Issue
1 - 1
Pages
58 - 74
Publication Date
2019/03/18
ISSN (Online)
2590-0048
DOI
https://doi.org/10.2991/chi.d.190310.001How to use a DOI?
Copyright
© 2019 International Academy for Clinical Hematology. Publishing services by Atlantis Press International B.V.
Open Access
This is an open access article distributed under the CC BY-NC 4.0 license (http://creativecommons.org/licenses/by-nc/4.0/).

Cite this article

TY  - JOUR
AU  - Ali Bazarbachi
AU  - Myriam Labopin
AU  - Giorgia Battipaglia
AU  - Azedine Djabali
AU  - Edouard Forcade
AU  - William Arcese
AU  - Gerard Socié
AU  - Didier Blaise
AU  - Joerg Halter
AU  - Sabine Gerull
AU  - Jan J. Cornelissen
AU  - Patrice Chevallier
AU  - Johan Maertens
AU  - Nicolaas Schaap
AU  - Jean El-Cheikh
AU  - Jordi Esteve
AU  - Arnon Nagler
AU  - Mohamad Mohty
PY  - 2019
DA  - 2019/03/18
TI  - Allogeneic Stem Cell Transplantation for FLT3-Mutated Acute Myeloid Leukemia: In vivo T-Cell Depletion and Posttransplant Sorafenib Maintenance Improve Survival. A Retrospective Acute Leukemia Working Party-European Society for Blood and Marrow Transplant Study
JO  - Clinical Hematology International
SP  - 58
EP  - 74
VL  - 1
IS  - 1
SN  - 2590-0048
UR  - https://doi.org/10.2991/chi.d.190310.001
DO  - https://doi.org/10.2991/chi.d.190310.001
ID  - Bazarbachi2019
ER  -