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Long-term outcomes in patients with relapsed/refractory acute myeloid leukemia and other high-risk myeloid malignancies after undergoing sequential conditioning regimen based on IDA-FLAG and high-dose melphalan

Bone Marrow Transplantation volume 57, pages 1304–1312 (2022)Cite this article

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Abstract

Allogeneic hematopoietic cell transplantation (alloHCT) remains the only curative option for relapsed/refractory acute myeloid leukemia and other high-risk myeloid malignancies. To improve alloHCT results in this setting, sequential regimens were designed as a strategy to lower tumor burden and quickly induce the graft-versus-leukemia effect. We analyzed long-term outcomes of a sequential regimen based on IDA-FLAG and high-dose melphalan, as set forth by the CETLAM cooperative group. This protocol yielded a high complete response rate (89%) and a lower cumulative relapse incidence (30% at five years) compared to other regimens. Five-year non-relapse mortality, however, reached 45%, with grade 3–4 acute graft-versus-host disease being the most frequent adverse event (a 100-day incidence of 29%). Altogether, 5-year overall survival was 25% in this group of patients with otherwise dismal prognosis. Long-term survivors enjoyed a good quality of life after a median follow-up of 68 months.

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Fig. 1: Main outcomes after alloHCT conditioned with the seq-HCT (IDA-FLAG+HD melphalan) regimen (overall series).
Fig. 2: Survival according to disease type and main prognostic factors in univariate analysis.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

This work was supported (in part) by grants from Fondo de Investigaciones Sanitarias/Instituto deSalud Carlos III (ISCIII): PI16/01027, PI19/1476, PI20/01621, PERIS from Generalitat de Catalunya SLT002/16/00433, SGR 1655, SGR 1395 and Premi Fi de Residència de la Societat Catalana d’Hematologia i Hemoteràpia per a la Investigació en Hematologia 2019.

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Authors and Affiliations

  1. Hospital Clinic de Barcelona, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain

    Francesca Guijarro, Alex Bataller, Marina Diaz-Beyá, Sandra Castaño-Díez, Carmen Martínez, María Suárez-Lledó, Francesc Fernández-Avilés, Montserrat Rovira & Jordi Esteve

  2. Josep Carreras Leukemia Research Institute, Badalona, Spain

    Alex Bataller, Marina Diaz-Beyá, Ana Garrido, Christelle Coll-Ferrà, Susana Vives, Carmen Martínez, María Suárez-Lledó, Francesc Fernández-Avilés, Josep Maria Ribera, Montserrat Rovira, Salut Brunet, Jorge Sierra & Jordi Esteve

  3. Hospital de la Santa Creu i Sant Pau, Barcelona, Spain

    Ana Garrido, Salut Brunet & Jorge Sierra

  4. ICO-Hospital Germans Trias i Pujol, Institut Català d’Oncologia, Badalona, Spain

    Christelle Coll-Ferrà, Susana Vives & Josep Maria Ribera

  5. Universitat de Vic-Universitat Central de Catalunya, Vic, Spain

    Christelle Coll-Ferrà

  6. Universitat Autònoma de Barcelona, Barcelona, Spain

    Susana Vives, Josep Maria Ribera, Salut Brunet & Jorge Sierra

  7. Hospital Vall d’Hebron, VHIO, Barcelona, Spain

    Olga Salamero & David Valcárcel

  8. Hospital Clínico de Valencia, INCLIVA Research Institute, Valencia, Spain

    Mar Tormo & Juan Carlos Hernández-Boluda

  9. Institut Català d’Oncologia, Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), L’Hospitalet de Llobregat, Spain

    Montserrat Arnan

  10. Hospital Son Espases, Institut d’Investigació Sanitària Illes Balears (IdISABa), Palma, Spain

    Antònia Sampol

  11. University of Barcelona, Barcelona, Spain

    Carmen Martínez, Montserrat Rovira & Jordi Esteve

Authors
  1. Francesca Guijarro
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  2. Alex Bataller
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Contributions

JE and JS were responsible for designing the protocol. FG, AG, CCF, SV, OS, DV, MT, MA, AS collected the clinical data. FG, AB, SCD, MDB, and JE analyzed the data and wrote the manuscript. AG, CCF, SV, OS, DV, MT, MA, AS, CM, MSL, FFA, JCHB, JMR, MR, SB, and JS interpreted results and provided feedback. All authors reviewed and accepted the manuscript.

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Correspondence to Jordi Esteve.

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Guijarro, F., Bataller, A., Diaz-Beyá, M. et al. Long-term outcomes in patients with relapsed/refractory acute myeloid leukemia and other high-risk myeloid malignancies after undergoing sequential conditioning regimen based on IDA-FLAG and high-dose melphalan. Bone Marrow Transplant 57, 1304–1312 (2022). https://doi.org/10.1038/s41409-022-01703-9

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