Annals of Hematology

, Volume 91, Issue 1, pp 47–55

Intermediate intensity conditioning regimen containing FLAMSA, treosulfan, cyclophosphamide, and ATG for allogeneic stem cell transplantation in elderly patients with relapsed or high-risk acute myeloid leukemia

  • Jens Marcus Chemnitz
  • Marie von Lilienfeld-Toal
  • Udo Holtick
  • Sebastian Theurich
  • Alexander Shimabukuro-Vornhagen
  • Anke Krause
  • Peter Brossart
  • Michael Hallek
  • Christof Scheid
Original Article

DOI: 10.1007/s00277-011-1253-9

Cite this article as:
Chemnitz, J.M., von Lilienfeld-Toal, M., Holtick, U. et al. Ann Hematol (2012) 91: 47. doi:10.1007/s00277-011-1253-9

Abstract

Lower dosage of total body irradiation (TBI) and chemotherapy in reduced-intensity conditioning (RIC) regimens prior to allogeneic stem cell transplantation have reduced the toxicity of the conditioning and non-relapse mortality. The FLAMSA–RIC protocol for high-risk patients with acute myeloid leukemia (AML) and myelodysplastic syndrome has shown promising results in refractory disease as well as in first complete remission. Still, the RIC protocol containing 4 Gy TBI/cyclophosphamide/anti-thymocyte globulin (ATG) implicates acute toxicity mainly due to TBI preventing its usage in patients with advanced age and/or severe co-morbidities. To increase feasibility and safety of the conditioning, we substituted TBI with treosulfan. Seventeen patients with relapsed or high-risk AML and either advanced age or concomitant disease were treated within a preparative regimen containing a 4-day course of chemotherapy (FLAMSA) followed by RIC comprising of treosulfan, cyclophosphamide, and ATG. After median follow-up of 12 months, the estimated incidences of relapse and non-relapse mortality were 25% and 20%, respectively. One-year overall survival was 62%. In conclusion, FLAMSA–treosulfan/cyclophosphamide/ATG is an intermediate intensity conditioning regimen with acceptable non-relapse mortality for patients with relapsed or high-risk AML. Substituting TBI with treosulfan provides an alternative to treat elderly patients or patients with severe co-morbidities when TBI appears not feasible due to the potential of increased toxicity.

Keywords

High-risk AML Allogeneic stem cell transplantation Reduced-intensity conditioning regimen Treosulfan Co-morbidity index 

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Jens Marcus Chemnitz
    • 1
  • Marie von Lilienfeld-Toal
    • 2
  • Udo Holtick
    • 1
  • Sebastian Theurich
    • 1
  • Alexander Shimabukuro-Vornhagen
    • 1
  • Anke Krause
    • 1
  • Peter Brossart
    • 2
  • Michael Hallek
    • 1
  • Christof Scheid
    • 1
  1. 1.BMT Program, Department I of Internal MedicineUniversity of CologneKölnGermany
  2. 2.Department III of Internal MedicineUniversity of BonnBonnGermany

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