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Fractionated gemtuzumab ozogamicin combined with intermediate-dose cytarabine and daunorubicin as salvage therapy in very high-risk AML patients: a bridge to reduced intensity conditioning transplant?

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Abstract

Outcome of patients with primary refractory/relapsed (R/R) acute myeloid leukemia (AML) remains dismal. Herein, we present a retrospective monocentric study of 24 very high-risk AML patients who received a combination of fractionated gemtuzumab ozogamicin (GO) with intermediate-dose cytarabine and daunorubicin as salvage therapy. Median age was 55.3 years. Diagnostic was secondary AML for 33% of them. Seven patients had favorable risk, 8 had intermediate-1 or intermediate-2, and 6 had unfavorable risk of AML according to the European LeukemiaNet prognostic index. Complete remission was achieved in 50% of cases (46% in refractory and 55% in relapsed AML) without excessive toxicity. Thirteen patients could be referred for transplant. Only allogeneic hematopoietic stem cell transplantation provided a benefit in this patient cohort with a 1-year overall survival of 50.7 versus 18.1% in the absence of transplantation. Patients treated with reduced intensity conditioning (RIC) showed a longer survival as compared to those undergoing myeloablative conditioning regimen mainly because of decreased toxicity.

Our data suggest that salvage therapy with fractionated GO combined with intermediate-dose cytarabine and daunorubicin in very high-risk patients may serve as a potential bridge therapy to RIC transplant.

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Authors and Affiliations

  1. Department of Hematology, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, 165, Chemin du Grand Revoyet, 69495-cedex, Pierre-Bénite, France

    Etienne Paubelle, Sophie Ducastelle-Leprêtre, Hélène Labussière-Wallet, Franck Emmanuel Nicolini, Fiorenza Barraco, Gilles Salles, Eric Wattel & Xavier Thomas

  2. Faculté de Médecine Lyon-Sud Charles Mérieux, Université de Lyon, Pierre Bénite, France

    Etienne Paubelle & Eric Wattel

  3. INSERM U1052, Centre de Recherche de Cancérologie de Lyon, Lyon, France

    Franck Emmanuel Nicolini

  4. Department of Biology, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France

    Adriana Plesa

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  1. Etienne Paubelle
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Correspondence to Etienne Paubelle.

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XT received consultancy fees from Pfizer. The other authors reported no potential conflicts of interest.

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Paubelle, E., Ducastelle-Leprêtre, S., Labussière-Wallet, H. et al. Fractionated gemtuzumab ozogamicin combined with intermediate-dose cytarabine and daunorubicin as salvage therapy in very high-risk AML patients: a bridge to reduced intensity conditioning transplant?. Ann Hematol 96, 363–371 (2017). https://doi.org/10.1007/s00277-016-2899-0

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