SALVAGE REGIMENT WITH FLAT FOR REFRACTORY AND RELAPSED AML: EXPERIENCE A SINGLE CENTRE.
(Abstract release date: 05/19/16)
EHA Library. Salamanca A. 06/09/16; 134567; PB1667
Dr. Araceli Salamanca
Contributions
Contributions
Abstract
Abstract: PB1667
Type: Publication Only
Background
Outcomes in patients with acute myeloid leukemia (AML) who are primary refractory or early relapsed are dismal, and there is not one standard therapy for all patients. Allogeneic hematopoietic stem cells transplantation (HSCT) is the treatment with the highest probability of cure when is possible to reduce the leukemia burden with salvage chemotherapy regimen prior to transplantation.
Aims
In this study, we report our experience of salvage chemotherapy regimen with fludarabine 30 mg/m2, cytarabine 2 g/m2 and topotecan 1.5 mg/m2 on days 1 to 4 (FLAT), for refractory or relapsed AML treated in our institution.
Methods
Analytical, observational and retrospective study. We included all patients treated with FLAT from 2008 to 2016 in our center. We studied disease status prior to salvage therapy (refractoriness to one or two previous regimens Vs early or late relapse), cytogenetic risk profile (favorable, intermediate or adverse), response (complete response [CR], partial response [PR] or refractory disease [RD]) and survival (overall survival [OS]).
Results
Twenty-four patients were treated with FLAT in the last eight years in our center. Median age at time of treatment was 55 years old (range 39-69). AML was the underlying condition in all individuals. Cytogenetic risk profile at diagnosis (ELN) was favorable in 2 patients, intermediate in 10 and adverse in 9 of them. It was not determinate in 3 patients. Ten patients received FLAT salvage course for primary refractory AML, 1 for secondary refractory AML, 11 for relapsed AML after chemotherapy and 2 for relapsed AML after stem cell transplant (allo-SCT).Median OS was 16 months (range 1-86), with median follow up of 41 months. OS in primary refractory AML was 20 months (1-84) and 14 months (3-86) in relapsed AML. RC rate after FLAT was 45.8% (11 patients), higher in refractory disease (7 out of 11). Treatment related mortality was 16%. After reaching CR or PR, 7 patients underwent allogeneic transplantation. In this group, OS was 23 months (2-84). Four patients did not undergo transplantation despite reaching CR because of infection complications or early relapse while unrelated donor search was activated. Four patients underwent a sequential approach with a third salvage chemotherapy and allo-SCT despite refractoriness to FLAT; two of them could reach CR with this approach.
Conclusion
FLAT is an efficient salvage regimen for refractory and relapse AML. An acceptable CR rate allowed patients to continue with allogeneic-SCT and a longer overall survival. This combination has an acceptable safety profile, even for the patients who were treated after transplant.
Session topic: E-poster
Type: Publication Only
Background
Outcomes in patients with acute myeloid leukemia (AML) who are primary refractory or early relapsed are dismal, and there is not one standard therapy for all patients. Allogeneic hematopoietic stem cells transplantation (HSCT) is the treatment with the highest probability of cure when is possible to reduce the leukemia burden with salvage chemotherapy regimen prior to transplantation.
Aims
In this study, we report our experience of salvage chemotherapy regimen with fludarabine 30 mg/m2, cytarabine 2 g/m2 and topotecan 1.5 mg/m2 on days 1 to 4 (FLAT), for refractory or relapsed AML treated in our institution.
Methods
Analytical, observational and retrospective study. We included all patients treated with FLAT from 2008 to 2016 in our center. We studied disease status prior to salvage therapy (refractoriness to one or two previous regimens Vs early or late relapse), cytogenetic risk profile (favorable, intermediate or adverse), response (complete response [CR], partial response [PR] or refractory disease [RD]) and survival (overall survival [OS]).
Results
Twenty-four patients were treated with FLAT in the last eight years in our center. Median age at time of treatment was 55 years old (range 39-69). AML was the underlying condition in all individuals. Cytogenetic risk profile at diagnosis (ELN) was favorable in 2 patients, intermediate in 10 and adverse in 9 of them. It was not determinate in 3 patients. Ten patients received FLAT salvage course for primary refractory AML, 1 for secondary refractory AML, 11 for relapsed AML after chemotherapy and 2 for relapsed AML after stem cell transplant (allo-SCT).Median OS was 16 months (range 1-86), with median follow up of 41 months. OS in primary refractory AML was 20 months (1-84) and 14 months (3-86) in relapsed AML. RC rate after FLAT was 45.8% (11 patients), higher in refractory disease (7 out of 11). Treatment related mortality was 16%. After reaching CR or PR, 7 patients underwent allogeneic transplantation. In this group, OS was 23 months (2-84). Four patients did not undergo transplantation despite reaching CR because of infection complications or early relapse while unrelated donor search was activated. Four patients underwent a sequential approach with a third salvage chemotherapy and allo-SCT despite refractoriness to FLAT; two of them could reach CR with this approach.
Conclusion
FLAT is an efficient salvage regimen for refractory and relapse AML. An acceptable CR rate allowed patients to continue with allogeneic-SCT and a longer overall survival. This combination has an acceptable safety profile, even for the patients who were treated after transplant.
Session topic: E-poster
Abstract: PB1667
Type: Publication Only
Background
Outcomes in patients with acute myeloid leukemia (AML) who are primary refractory or early relapsed are dismal, and there is not one standard therapy for all patients. Allogeneic hematopoietic stem cells transplantation (HSCT) is the treatment with the highest probability of cure when is possible to reduce the leukemia burden with salvage chemotherapy regimen prior to transplantation.
Aims
In this study, we report our experience of salvage chemotherapy regimen with fludarabine 30 mg/m2, cytarabine 2 g/m2 and topotecan 1.5 mg/m2 on days 1 to 4 (FLAT), for refractory or relapsed AML treated in our institution.
Methods
Analytical, observational and retrospective study. We included all patients treated with FLAT from 2008 to 2016 in our center. We studied disease status prior to salvage therapy (refractoriness to one or two previous regimens Vs early or late relapse), cytogenetic risk profile (favorable, intermediate or adverse), response (complete response [CR], partial response [PR] or refractory disease [RD]) and survival (overall survival [OS]).
Results
Twenty-four patients were treated with FLAT in the last eight years in our center. Median age at time of treatment was 55 years old (range 39-69). AML was the underlying condition in all individuals. Cytogenetic risk profile at diagnosis (ELN) was favorable in 2 patients, intermediate in 10 and adverse in 9 of them. It was not determinate in 3 patients. Ten patients received FLAT salvage course for primary refractory AML, 1 for secondary refractory AML, 11 for relapsed AML after chemotherapy and 2 for relapsed AML after stem cell transplant (allo-SCT).Median OS was 16 months (range 1-86), with median follow up of 41 months. OS in primary refractory AML was 20 months (1-84) and 14 months (3-86) in relapsed AML. RC rate after FLAT was 45.8% (11 patients), higher in refractory disease (7 out of 11). Treatment related mortality was 16%. After reaching CR or PR, 7 patients underwent allogeneic transplantation. In this group, OS was 23 months (2-84). Four patients did not undergo transplantation despite reaching CR because of infection complications or early relapse while unrelated donor search was activated. Four patients underwent a sequential approach with a third salvage chemotherapy and allo-SCT despite refractoriness to FLAT; two of them could reach CR with this approach.
Conclusion
FLAT is an efficient salvage regimen for refractory and relapse AML. An acceptable CR rate allowed patients to continue with allogeneic-SCT and a longer overall survival. This combination has an acceptable safety profile, even for the patients who were treated after transplant.
Session topic: E-poster
Type: Publication Only
Background
Outcomes in patients with acute myeloid leukemia (AML) who are primary refractory or early relapsed are dismal, and there is not one standard therapy for all patients. Allogeneic hematopoietic stem cells transplantation (HSCT) is the treatment with the highest probability of cure when is possible to reduce the leukemia burden with salvage chemotherapy regimen prior to transplantation.
Aims
In this study, we report our experience of salvage chemotherapy regimen with fludarabine 30 mg/m2, cytarabine 2 g/m2 and topotecan 1.5 mg/m2 on days 1 to 4 (FLAT), for refractory or relapsed AML treated in our institution.
Methods
Analytical, observational and retrospective study. We included all patients treated with FLAT from 2008 to 2016 in our center. We studied disease status prior to salvage therapy (refractoriness to one or two previous regimens Vs early or late relapse), cytogenetic risk profile (favorable, intermediate or adverse), response (complete response [CR], partial response [PR] or refractory disease [RD]) and survival (overall survival [OS]).
Results
Twenty-four patients were treated with FLAT in the last eight years in our center. Median age at time of treatment was 55 years old (range 39-69). AML was the underlying condition in all individuals. Cytogenetic risk profile at diagnosis (ELN) was favorable in 2 patients, intermediate in 10 and adverse in 9 of them. It was not determinate in 3 patients. Ten patients received FLAT salvage course for primary refractory AML, 1 for secondary refractory AML, 11 for relapsed AML after chemotherapy and 2 for relapsed AML after stem cell transplant (allo-SCT).Median OS was 16 months (range 1-86), with median follow up of 41 months. OS in primary refractory AML was 20 months (1-84) and 14 months (3-86) in relapsed AML. RC rate after FLAT was 45.8% (11 patients), higher in refractory disease (7 out of 11). Treatment related mortality was 16%. After reaching CR or PR, 7 patients underwent allogeneic transplantation. In this group, OS was 23 months (2-84). Four patients did not undergo transplantation despite reaching CR because of infection complications or early relapse while unrelated donor search was activated. Four patients underwent a sequential approach with a third salvage chemotherapy and allo-SCT despite refractoriness to FLAT; two of them could reach CR with this approach.
Conclusion
FLAT is an efficient salvage regimen for refractory and relapse AML. An acceptable CR rate allowed patients to continue with allogeneic-SCT and a longer overall survival. This combination has an acceptable safety profile, even for the patients who were treated after transplant.
Session topic: E-poster
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