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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

2022; Springer Nature; Volume: 57; Issue: 6 Linguagem: Inglês

10.1038/s41409-022-01626-5

1476-5365

Francesca Bonifazi, Chiara Pavoni, Jacopo Peccatori, Fabio Giglio, Mario Arpinati, Alessandro Busca, Paolo Bernasconi, Anna Grassi, Anna Paola Iori, Fabrizio Patriarca, Lucia Brunello, Carmen Di Grazia, Angelo Michele Carella, Daniela Cilloni, Alessandra Picardi, Anna Proia, Stella Santarone, Roberto Sorasio, Paola Carluccio, Patrizia Chiusolo, Alessandra Cupri, Mario Luppi, Chiara Nozzoli, D Baronciani, Marco Casini, Giovanni Grillo, Maurizio Musso, Francesco Onida, Giulia Palazzo, Matteo Parma, Stefania Tringali, Adriana Vacca, Daniele Vallisa, Nicoletta Sacchi, Elena Oldani, Arianna Masciulli, Angela Gheorghiu, Corrado Girmenia, Massimo Martino, Benedetto Bruno, Alessandro Rambaldi, Fabio Ciceri,

Acute Lymphoblastic Leukemia research

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.