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
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- Allogeneic stem cell transplantation; Acute myeloid leukemia; FLT3 mutation; In vivo T-cell depletion; Sorafenib
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.
- © 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 -