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High-dose melphalan is an effective salvage therapy in acute myeloid leukaemia patients with refractory relapse and relapse after autologous stem cell transplantation

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Abstract

In a pilot study high-dose melphalan (HD-Mel, 200 mg/m2) and autologous stem cell transplantation (ASCT) were administered to 14 patients (median age 52, range 29–60 years) with acute myeloid leukaemia (AML) in first relapse after a previous ASCT in first complete remission (n=11) or chemotherapy (n=3). A first cohort of five patients received HD-Mel as salvage therapy after a previous cycle of mitoxantrone, topotecan and cytarabine (MTC) had failed in four out of five patients, while a second cohort of nine patients received HD-Mel in untreated relapse. Thirteen (93%) of 14 patients achieved a second complete remission (CR2), including all four patients who had been refractory to MTC. No treatment-related mortality was observed after HD-Mel. Thirteen (93%) patients were able to proceed to a dose-reduced allogeneic stem cell transplantation (allo-SCT) from human-leucocyte-antigens-compatible unrelated (n=12) or sibling donors (n=1) in CR2 (n=11) or poor recovery/relapse (n=2) after a median of 2 (1.7–4.5) months following HD-Mel. Three MTC-refractory patients, but none of the upfront HD-Mel patients, died due to an allograft-related non-relapse cause. Nine patients are alive in CR2 after a median of 6 (2–49) months after HD-Mel and a median of 4 (0.6–47) months after a sequential allo-SCT. Although median follow-up is still short, the proportion of patients achieving a CR2, as well as of those proceeding to a subsequent reduced-intensity-conditioning-allo-SCT, is superior to those previously reported. Our results highly encourage to further investigate HD-Mel and ASCT as a promising salvage regimen for relapsed AML patients for whom autologous peripheral blood stem cells are available.

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Acknowledgements

This work was supported by the Alfred und Angelika Gutermuth-Stiftung. The authors thank the haematology nursing staff for their excellent patient care.

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Authors and Affiliations

  1. Medizinische Klinik II, Klinikum der J.W. Goethe-Universität Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany

    Gesine Bug, Johannes Atta, Stefan A. Klein, Lothar Bergmann, Simone Boehrer, Sabine Mousset, Dieter Hoelzer & Hans Martin

  2. Abt. Hämatologie/Onkologie, Medizinische Hochschule Hannover, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany

    Bernd Hertenstein

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  1. Gesine Bug
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  2. Johannes Atta
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  3. Stefan A. Klein
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Correspondence to Gesine Bug.

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Bug, G., Atta, J., Klein, S.A. et al. High-dose melphalan is an effective salvage therapy in acute myeloid leukaemia patients with refractory relapse and relapse after autologous stem cell transplantation. Ann Hematol 84, 748–754 (2005). https://doi.org/10.1007/s00277-005-1075-8

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  • DOI: https://doi.org/10.1007/s00277-005-1075-8

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