Conditioning regimens for older AML patients undergoing ASCT promising

NEW YORK (Reuters Health) - In elderly acute myeloid leukemia (AML) patients undergoing autologous stem cell transplantation (ASCT), a conditioning regimen consisting of 2 days of continuous infusion idarubicin at a dose of 20 mg/m�/d followed by 3 days oral or IV busulphan (4mg/kg/d) is safe and has the potential to prolong the duration of complete remission and survival, a study shows.

"Best results are achievable in patients with normal karyotype, while alternative approaches are clearly needed in cases with adverse cytogenetics at diagnosis," Dr. Felicetto Ferrara and colleagues from the stem cell transplantation unit at Cardarelli Hospital in Napoli note in an online report published February 10 in the journal Hematology Oncology.

The investigators describe the results of 40 AML patients older than 60 years (32% older than age 70 years) who were autografted in the first complete remission after conditioning with the high-dose idarubicin and busulphan regimen.

No transplant-related mortalities or cases of cardiac toxicity occurred, according to the team, but 31 patients (77%) developed grade 3-4 mucositis.

After a median follow up of 25 months, median disease-free survival and overall survival for the whole patient population were 13 and 22 months, respectively. Three patients died while in complete remission from causes unrelated to AML.

Disease-free survival was much shorter for the 8 patients with adverse cytogenetics as compared to the 28 with normal karyotype (median 8 months vs 48 months), which was "disappointing," the researchers say.

"Our data...strongly suggest the opportunity of allocating older AML patients with unfavorable karyotype into experimental trials, based on new agents, such as clofarabine or cloretazine, potentially able to overcome the adverse prognostic relevance of adverse karyotypic alterations," the investigators conclude.

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