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Yeshurun M.,Institute of Hematology | Yeshurun M.,Tel Aviv University | Labopin M.,Clinical Hematology and Cellular Therapy | Labopin M.,European Group for Blood and Marrow Transplantation Acute Leukemia Working Party Office | And 21 more authors.
Cancer | Year: 2014

BACKGROUND The objective of the current study was to investigate the role of postremission consolidation chemotherapy before reduced-intensity conditioning (RIC) allogeneic stem cell transplantation (alloSCT) for patients with acute myeloid leukemia (AML) in first complete remission (CR1). METHODS Of the 789 consecutive patients with AML in CR1 who underwent RIC alloSCT from a human leukocyte antigen-matched sibling or matched unrelated donor peripheral stem cell grafts between 2001 and 2010, 591 patients received at least 1 cycle of consolidation chemotherapy and 198 patients did not receive any consolidation chemotherapy before alloSCT. To minimize inherent survival bias in favor of patients who underwent transplant long after achieving CR1, the study focused on 373 patients who underwent transplant within the median time frame between achievement of CR1 and alloSCT (3 months for patients who underwent alloSCT from matched siblings and 4 months for patients who underwent alloSCT from matched unrelated donors). In this subgroup, 151 patients did not receive any consolidation chemotherapy and 222 patients received ≥ 1 consolidation chemotherapy cycle. RESULTS With a median follow-up of 36 months (range, 2 months-135 months), the 3-year cumulative recurrence incidence (RI) was not significantly different between the groups (36% ± 4% for the group treated without consolidation chemotherapy vs 38% ± 3% for patients who received consolidation chemotherapy; P =.89). In addition, leukemia-free survival was similar between the groups (45% ± 4% and 47% ± 3%, respectively; P =.41). Dose intensity of cytarabine given during consolidation chemotherapy appeared to have no influence on RI. On multivariate analysis, pretransplant consolidation (≥ 1 cycle vs 0 cycles) was found to have no significant impact on RI (hazards ratio, 1.29; 95% confidence interval, 0.84-1.97 [P =.24]) or leukemia-free survival (hazards ratio, 1.00; 95% confidence interval, 0.71-1.42 [P =.99]). CONCLUSIONS The data from the current study suggest no apparent advantage for postremission consolidation chemotherapy before RIC alloSCT, provided a donor is readily available. Cancer 2014;120:855-863. © 2013 American Cancer Society. There is no apparent advantage for postremission consolidation chemotherapy before reduced-intensity conditioning allogeneic stem cell transplantation for patients with acute myeloid leukemia in first complete response. Provided a suitable donor is readily available, transplantation should be offered promptly at the time the first complete response is achieved, without undue delay. © 2013 American Cancer Society. Source


Schmidt-Hieber M.,HELIOS Clinic Berlin Buch | Schmidt-Hieber M.,Charite - Medical University of Berlin | Labopin M.,European Group for Blood and Marrow Transplantation Acute Leukemia Working Party Office | Labopin M.,University Pierre and Marie Curie | And 16 more authors.
Blood | Year: 2013

We analyzed the prognostic impact of donor and recipient cytomegalovirus (CMV) serostatus in 16628 de novo acute leukemia patients after allogeneic stem cell transplantation (allo-SCT). Compared with CMV-seronegative recipients who underwent allograft from a CMV-seronegative donor, cases of CMV seropositivity of the donor and/or the recipient showed a significantly decreased 2-year leukemia-free survival (44% vs 49%, P Source


Giebel S.,Institute of Oncology | Miszczyk L.,Oncology and Radiotherapy Institute | Slosarek K.,Oncology and Radiotherapy Institute | Moukhtari L.,European Group for Blood and Marrow Transplantation Acute Leukemia Working Party Office | And 13 more authors.
Cancer | Year: 2014

BACKGROUND Total body irradiation (TBI) is widely used for conditioning before hematopoietic cell transplantation. Its efficacy and toxicity may depend on many methodological aspects. The goal of the current study was to explore current clinical practice in this field. METHODS A questionnaire was sent to all centers collaborating in the European Group for Blood and Marrow Transplantation and included 19 questions regarding various aspects of TBI. A total of 56 centers from 23 countries responded. RESULTS All centers differed with regard to at least 1 answer. The total maximum dose of TBI used for myeloablative transplantation ranged from 8 grays (Gy) to 14.4 Gy, whereas the dose per fraction was 1.65 Gy to 8 Gy. A total of 16 dose/fractionation modalities were identified. The dose rate ranged from 2.25 centigrays to 37.5 centigrays per minute. The treatment unit was linear accelerator (LINAC) (91%) or cobalt unit (9%). Beams (photons) used for LINAC were reported to range from 6 to 25 megavolts. The most frequent technique used for irradiation was "patient in 1 field," in which 2 fields and 2 patient positions per fraction are used (64%). In 41% of centers, patients were immobilized during TBI. Approximately 93% of centers used in vivo dosimetry with accepted discrepancies between the planned and measured doses of 1.5% to 10%. In 84% of centers, the lungs were shielded during irradiation. The maximum accepted dose for the lungs was 6 Gy to 14.4 Gy. CONCLUSIONS TBI is an extremely heterogeneous treatment modality. The findings of the current study should warrant caution in the interpretation of clinical studies involving TBI. Further investigation is needed to evaluate how methodological differences influence outcome. Efforts to standardize the method should be considered. Cancer 2014;120:2760-2765. © 2014 American Cancer Society. Results of the current survey analysis indicate that total body irradiation is an extremely heterogeneous treatment modality. The differences between treatment centers may influence both the efficacy and toxicity of the procedure. © 2014 American Cancer Society. Source

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