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Büchner (Abstract)

Cellular Therapy and Transplantation (CTT), Vol. 3, No. 9
doi: 10.3205/ctt-2010-No9-abstract75
© The Authors. This abstract is provided under the following license: Creative Commons Attribution 3.0 Unported

Abstract accepted for "4th Raisa Gorbacheva Memorial Meeting on Hematopoietic Stem Cell Transplantation",
Saint Petersburg, Russia, September 18–20, 2010

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Strategies against relapse in AML

Thomas Büchner

University of Münster, Germany

Correspondence: Thomas Büchner MD PhD, Professor of Medicine and Hematology, University of Münster, Germany, E-mail: buechnr@spam is baduni-muenster.de

Abstract

It is again a great privilege to give the Raisa Gorbacheva Memorial Lecture. Let me use this chance to discuss latest results from the AML Cooperative Group (AMLCG) and also some other study groups in Germany with this distinguished international audience.

After improving the supportive care and optimizing induction therapy, relapse has emerged as the dominant problem in AML. While AML has become a curable disease in a sector of patients, a relapse reduces their survival to zero. It is therefore essential to focus on the relapse rate (RR) as a separate endpoint. Similarly to complete remission and overall survival, the RR from the 1st remission is determined by factors such as de novo versus secondary AML, cytogenetic groups, mutation in NPM1, FLT3, CEBPA and others, LDH and WBC (figure 1).

Figure 1.

Also, age has emerged as a risk factor, even under homogenous therapy as administered in patients under age 60 years (figure 2). The impact of age is seen across all risk groups.

Figure 2.

Now, what is the influence of treatment on the RR? In the 1999 trial by the AMLCG we compared two differently intensive inductions (TAD-HAM vs. HAM-HAM), G-CSF priming vs. no G-CSF, and also maintenance chemotherapy vs. autologous stem cell transplantation. The only significant but modest reduction in the relapse rate was produced by the more intensive HAM-HAM induction (figure 3).

Figure 3.

Apart from the randomized comparisons, 204 patients underwent allogeneic stem cell transplantation in the 1st CR. When comparing the transplanted with a non-transplanted group using a landmark analysis there is a marked reduction in RR of the alloSCT patients: suggesting a highly effective graft-versus-leukemia mechanism (figure 4). Furthermore, we looked at 159 patients receiving allogeneic SCT after relapse. Projected to 5 years after relapse their survival is 34% vs. 12% (p<0.001) in the non-transplanted group.

Figure 4.

Therefore, among the novel therapeutic approaches in AML, the extension and optimization of allogeneic SCT deserves a particular role.

 

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