1. Myeloablative conditioning with thiotepa-busulfan-fludarabine does not improve the outcome of patients transplanted with active leukemia: final results of the GITMO prospective trial GANDALF-01
- Author
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Bonifazi, F., Pavoni, C., Peccatori, J., Giglio, F., Arpinati, M., Busca, A., Bernasconi, P., Grassi, A., Iori, A. P., Patriarca, F., Brunello, L., Di Grazia, C., Carella, A. M., Cilloni, D., Picardi, A., Proia, A., Santarone, S., Sorasio, R., Carluccio, P., Chiusolo, Patrizia, Cupri, A., Luppi, M., Nozzoli, C., Baronciani, D., Casini, M., Grillo, G., Musso, M., Onida, F., Palazzo, G., Parma, M., Tringali, S., Vacca, A., Vallisa, D., Sacchi, N., Oldani, E., Masciulli, A., Gheorghiu, A., Girmenia, C., Martino, M., Bruno, B., Rambaldi, A., Ciceri, F., Chiusolo P. (ORCID:0000-0002-1355-1587), Bonifazi, F., Pavoni, C., Peccatori, J., Giglio, F., Arpinati, M., Busca, A., Bernasconi, P., Grassi, A., Iori, A. P., Patriarca, F., Brunello, L., Di Grazia, C., Carella, A. M., Cilloni, D., Picardi, A., Proia, A., Santarone, S., Sorasio, R., Carluccio, P., Chiusolo, Patrizia, Cupri, A., Luppi, M., Nozzoli, C., Baronciani, D., Casini, M., Grillo, G., Musso, M., Onida, F., Palazzo, G., Parma, M., Tringali, S., Vacca, A., Vallisa, D., Sacchi, N., Oldani, E., Masciulli, A., Gheorghiu, A., Girmenia, C., Martino, M., Bruno, B., Rambaldi, A., Ciceri, F., and Chiusolo P. (ORCID:0000-0002-1355-1587)
- Abstract
The outcome of refractory/relapsed (R/R) acute leukemias is still dismal and their treatment represents an unmet clinical need. However, allogeneic transplantation (allo-HSCT) remains the only potentially curative approach in this setting. A prospective study (GANDALF-01, NCT01814488; EUDRACT:2012-004008-37) on transplantation with alternative donors had been run by GITMO using a homogeneous myeloablative conditioning regimen with busulfan, thiotepa and fludarabine while GVHD prophylaxis was stratified by donor type. The study enrolled 101 patients; 90 found an alternative donor and 87 ultimately underwent allo-HSCT. Two-year overall survival of the entire and of the transplant population (primary endpoint) were 19% and 22%, without significant differences according to disease, donor type and disease history (relapsed vs refractory patients). Two-year progression-free survival was 19% and 17% respectively. The cumulative incidences of relapse and non-relapse mortality were 49% and 33% at two years. Acute grade II-IV and chronic GVHD occurred in 23 and 10 patients. Dose intensification with a myeloablative two-alkylating regimen as sole strategy for transplanting R/R acute leukemia does seem neither to improve the outcome nor to control disease relapse. A pre-planned relapse prevention should be included in the transplant strategy in this patient population.
- Published
- 2022