Conditioning with Treosulfan and Fludarabine followed by Allogeneic Hematopoietic Cell Transplantation for High-Risk Hematologic Malignancies

Eneida R. Nemecek, Katherine A. Guthrie, Mohamed L. Sorror, Brent L. Wood, Kristine C. Doney, Ralf A. Hilger, Bart L. Scott, Tibor J. Kovacsovics, Richard T. Maziarz, Ann E. Woolfrey, Antonio Bedalov, Jean E. Sanders, John M. Pagel, Eileen J. Sickle, Robert Witherspoon, Mary E. Flowers, Frederick R. Appelbaum, H. Joachim Deeg

Research output: Contribution to journalArticle

70 Scopus citations

Abstract

In this prospective study 60 patients of median age 46 (range: 5-60 years), with acute myelogenous leukemia (AML; n = 44), acute lymphoblastic leukemia (ALL; n = 3), or myelodysplastic syndrome (MDS; n = 13) were conditioned for allogeneic hematopoietic cell transplantation with a treosulfan/fludarabine (Flu) combination. Most patients were considered at high risk for relapse or nonrelapse mortality (NRM). Patients received intravenous treosulfan, 12 g/m2/day (n = 5) or 14 g/m2/day (n = 55) on days -6 to -4, and Flu (30 mg/m2/day) on days -6 to -2, followed by infusion of marrow (n = 7) or peripheral blood stem cells (n = 53) from HLA-identical siblings (n = 30) or unrelated donors (n = 30). All patients engrafted. NRM was 5% at day 100, and 8% at 2 years. With a median follow-up of 22 months, the 2-year relapse-free survival (RFS) for all patients was 58% and 88% for patients without high-risk cytogenetics. The 2-year cumulative incidence of relapse was 33% (15% for patients with MDS, 34% for AML in first remission, 50% for AML or ALL beyond first remission and 63% for AML in refractory relapse). Thus, a treosulfan/Flu regimen was well tolerated and yielded encouraging survival and disease control with minimal NRM. Further trials are warranted to compare treosulfan/Flu to other widely used regimens, and to study the impact of using this regimen in more narrowly defined groups of patients.

Original languageEnglish (US)
Pages (from-to)341-350
Number of pages10
JournalBiology of Blood and Marrow Transplantation
Volume17
Issue number3
DOIs
StatePublished - Mar 1 2011

Keywords

  • Acute leukemia
  • Bone marrow transplantation
  • Myelodysplastic syndrome
  • Reduced intensity
  • Treosulfan

ASJC Scopus subject areas

  • Hematology
  • Transplantation

Fingerprint Dive into the research topics of 'Conditioning with Treosulfan and Fludarabine followed by Allogeneic Hematopoietic Cell Transplantation for High-Risk Hematologic Malignancies'. Together they form a unique fingerprint.

  • Cite this

    Nemecek, E. R., Guthrie, K. A., Sorror, M. L., Wood, B. L., Doney, K. C., Hilger, R. A., Scott, B. L., Kovacsovics, T. J., Maziarz, R. T., Woolfrey, A. E., Bedalov, A., Sanders, J. E., Pagel, J. M., Sickle, E. J., Witherspoon, R., Flowers, M. E., Appelbaum, F. R., & Deeg, H. J. (2011). Conditioning with Treosulfan and Fludarabine followed by Allogeneic Hematopoietic Cell Transplantation for High-Risk Hematologic Malignancies. Biology of Blood and Marrow Transplantation, 17(3), 341-350. https://doi.org/10.1016/j.bbmt.2010.05.007