Calanque d’En-Vaux, Marseille

Allogeneic SCT for refractory LeukemiaYES or NO?

Pr. Didier Blaise, MDCOSTEM 2011, Berlin, September 9th – 11th

ANSWER

Recent achievements N=100 Age: 50 (18-64) CDT: RIC = 100%

CR1-2/CP1 AL/CL + age < 50: 24%

5 year LFS: 69% (48-84)

Refractory Status?

• Primary failure• Refractory relapse• Untreated Relapse

Ravandi F et al. Blood 2010;116:5818-5823

Consensus… five years ago?

Bone Marrow Transplant, 2006

Are old papers valuable?

Institut Paoli CalmettesExperience 2000-2010: Allo-SCT for AML

Complete Remission Refractory / Relapse

N 188 30Âge 51 (18-69) 46 (18-67)Donor MSIB / MMRelated 61% / 1% 57% / 6% MUD / MMUD 20% / 18% 27% / 10%CDT Standard CyTBI/BuCy RIC RTC

11%74%15%

20%66%13%

Institut Paoli CalmettesExperience 2000-2010: Allo-SCT for AML

Complete Remission Refractory / Relapse

N 188 30NRM 15% 13%Relapse Days to relapse

20% 119 (14-1188)

56% 85 (19-2758)

Alive 68% 36%

Major Bias 100% Patients analyzed have effectively been transplanted

• When transplant performed • 2/3 CR• Allogeneic effect (Plateau after 2-3 years)• Long term survival achievable• Standard DLI not efficient to control further relapse

• Predictive factors• Tumor burden is the major factor• In some situations, high survival• In some situations, transplant is futile• RIC is an option

THESE ARE NOT RESULTS IN REFRACTORY AML PTSBUT IN PTS TRANSPLANTED!!!

Conclusions

• Transplant in refractory situation ? NO• There are alternatives: Phase 1

• Transplant in young vs. older patients? NO• Transplant in subpopulation with specific features? NO

• Low tumor burden• Low number of chemotherapy course

• Relapse vs. PIF different problematic? NO

Is it a definitive NO?

• Except if you set up your program to be successful• Anticipate refractoriness at induction and pts to relapse

• Systematic HLA typing• Early Donor search

• Specific transplant program• Reduced toxicity CDT

• Early and pro-active post transplant strategy• Early cellular immunotherapy• Vaccination• Post graft treatments

• Aim to include patients in protocols• Boy! That’s a real job!

And if failure…

Backups

Institut Paoli Calmettes , MarseilleS Furst, C Faucher, J El Cheikh, L Castagna, R Crocchiolo

CHU Hotel Dieu, NantesM Mohty, P Chevallier

CHU Haut Lévèque, PessacN Milpied, R Tabrizi

CHU Lapeyronie, MontpellierN Fégueux

CHU E Herriot, Lyon,M Michallet

CHU Hôtel Dieu, Clermont-Ferrand JO Bay

CHU A Michallon, GrenobleJY Cahn

CHU, NiceA Sirvent

Statistiques and data management, IPC, MarseilleJM Boher, A Boyer Chammard

ANSWER

Probably NO???YES Perhaps???Could you repeat your question?

ACKNOWLEDGEMENTS