Impact of Remission Induction Chemotherapy Prior to Allogeneic SCT in Relapsed and Poor-response Patients With AML

Prior treatment

• For patients in the poor - responder stratum the first cycle of induction therapy must not contain HDAC, defined as cytarabine at single-doses of \> 1 g / m 2.
• Patient has received more than 440 mg / m2 daunorubicin equivalents.
• Treatment with any investigational drug within 10 days before study entry.
• Men unable or unwilling to use adequate contraception methods from start of study treatment to minimum of six months after the last dose of chemotherapy.

Other illness

• Uncontrolled infection at the time of enrollment.
• History of allogeneic transplantation.

Lab values

• WBC count of ≥ 50 GPt / L at study inclusion.
• Left ventricular ejection fraction \< 50 percent.
• Serum bilirubin \> 1.5 x ULN ( if not considered Gilbert-Syndrome ), ASAT / ALAT \> 5 x ULN.
• Estimated GFR \< 50 ml / min.

Other

• Acute promyelocytic leukemia ( APL ).
• Severe organ dysfunction, defined as
• Patients who receive supplementary continuous oxygen.
• Manifestation of AML in the central nervous system.
• Pregnant or breast - feeding women.
• Women of childbearing potential except those who fulfill the following criteria: Post-menopausal or post-operative or continuous and correct application of a contraception method with a Pearl Index \< 1 percent or sexual abstinence or vasectomy of the sexual partner.

• Signed written informed consent.
• Male and female patients of 18 to 75 years of age.
• Diagnosis of AML according to WHO criteria.
• Patient is fit for aggressive induction chemotherapy and transplantation by assessment of an experienced hematologist.
• No history of chronic pulmonary disease and absence of dyspnea. Otherwise, documented diffusion lung capacity for carbon monoxide ( DLCO ) ≤ 40 percent ( adjusted for hemoglobin, if available ) and FEV1 / FVC ≥ 50 percent.
• HLA - identical sibling. or
• HLA - compatible unrelated donor ( ≥ 9 /10 antigens matched for HLA - A, - B, - C, -DRB 1, and - DQB 1 ) with completed confirmatory typing or
• Two unrelated donors with \> 90 percent probability of a 9 /10 match for HLA - A, - B, - C, - DRB 1, and - DRQB 1, according to Opti Match ® list.
  • For the relapse stratum
• First AML relapse, defined as ≥ 5 percent bone marrow blasts and / or extramedullary AML manifestation.
  • For the poor - responders stratum
• AML that evolves from previously documented myelodysplastic syndrome ( MDS ),
  • and / or
• diagnosis of therapy-related myeloid neoplasm ( t - MN ), and / or
  • a ) If patient ≤ 60 years old adverse risk AML according to ELN - criteria and ≥ 5 percent bone marrow blasts after the first cycle of induction therapy.
  • b ) If patient \> 60 years old non-favourable risk AML according to ELN - criteria and ≥ 5 percent bone marrow blasts after the first cycle of induction therapy.