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Braess J, Amler S, Kreuzer KA, Spiekermann K, Lindemann HW, Lengfelder E, Graeven U, Staib P, Ludwig WD, Biersack H, Ko YD, Uppenkamp MJ, De Wit M, Korsten S, Peceny R, Gaska T, Schiel X, Behringer DM, Kiehl MG, Zinngrebe B, Meckenstock G, Roemer E, Medgenberg D, Spaeth-Schwalbe E, Massenkeil G, Hindahl H, Schwerdtfeger R, Trenn G, Sauerland C, Koch R, Lablans M, Faldum A, Görlich D, Bohlander SK, Schneider S, Dufour A, Buske C, Fiegl M, Subklewe M, Braess B, Unterhalt M, Baumgartner A, Wörmann B, Beelen D, Hiddemann W. Sequential high-dose cytarabine and mitoxantrone (S-HAM) versus standard double induction in acute myeloid leukemia-a phase 3 study. Leukemia 2018; 32:2558-2571. [PMID: 30275528 PMCID: PMC6286323 DOI: 10.1038/s41375-018-0268-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 07/26/2018] [Accepted: 08/09/2018] [Indexed: 01/17/2023]
Abstract
Dose-dense induction with the S-HAM regimen was compared to standard double induction therapy in adult patients with newly diagnosed acute myeloid leukemia. Patients were centrally randomized (1:1) between S-HAM (2nd chemotherapy cycle starting on day 8 = “dose-dense”) and double induction with TAD-HAM or HAM(-HAM) (2nd cycle starting on day 21 = “standard”). 387 evaluable patients were randomly assigned to S-HAM (N = 203) and to standard double induction (N = 184). The primary endpoint overall response rate (ORR) consisting of complete remission (CR) and incomplete remission (CRi) was not significantly different (P = 0.202) between S-HAM (77%) and double induction (72%). The median overall survival was 35 months after S-HAM and 25 months after double induction (P = 0.323). Duration of critical leukopenia was significantly reduced after S-HAM (median 29 days) versus double induction (median 44 days)—P < 0.001. This translated into a significantly shortened duration of hospitalization after S-HAM (median 37 days) as compared to standard induction (median 49 days)—P < 0.001. In conclusion, dose-dense induction therapy with the S-HAM regimen shows favorable trends but no significant differences in ORR and OS compared to standard double induction. S-HAM significantly shortens critical leukopenia and the duration of hospitalization by 2 weeks.
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Affiliation(s)
- Jan Braess
- Department of Oncology and Hematology, Hospital Barmherzige Brüder, Regensburg, Germany. .,Department of Medicine III, University Hospital LMU Campus Grosshadern, Munich, Germany.
| | - Susanne Amler
- Insitute for Biostatistics and Clinical Research, University Hospital, Münster, Germany.,Friedrich Löffler Institute, Federal Research Centre, Greifswald-Insel Riems, Germany
| | - Karl-Anton Kreuzer
- Department of Internal Medicine I, University Hospital, Cologne, Germany
| | - Karsten Spiekermann
- Department of Medicine III, University Hospital LMU Campus Grosshadern, Munich, Germany
| | | | - Eva Lengfelder
- Department of Medicine III, University Hospital, Mannheim, Germany
| | - Ullrich Graeven
- Department of Medicine I, Hospital Maria Hilf, Mönchengladbach, Germany
| | - Peter Staib
- Department of Hematology and Medical Oncology, St. Antonius Hospital, Eschweiler, Germany
| | - Wolf-Dieter Ludwig
- Department of Hematology and Oncology and Tumor Immunology, Helios Hospital, Berlin-Buch, Germany
| | - Harald Biersack
- Department of Medicine I, University Hospital, Lübeck, Germany
| | - Yon-Dschun Ko
- Department of Medicine I, Johanniter Hospital, Bonn, Germany
| | | | - Maike De Wit
- Department of Hematology, Oncology and Palliative Care, Vivantes Klinikum Neukölln, Berlin, Germany
| | - Stefan Korsten
- Department of Medicine, Vinzenz Pallotti Hospital, Bergisch-Gladbach, Germany
| | - Rudolf Peceny
- Department of Hematology and Oncology, Klinikum Osnabrück, Osnabrück, Germany
| | - Tobias Gaska
- Department of Hematology and Oncology, St. Josef Hospital, Paderborn, Germany
| | - Xaver Schiel
- Department of Hematology and Oncology, Klinikum Harlaching, Munich, Germany
| | - Dirk M Behringer
- Department of Hematology, Oncology and Palliative Care, Augusta Hospital, Bochum, Germany
| | - Michael G Kiehl
- Department of Medicine I, Klinikum Frankfurt/Oder, Frankfurt/Oder, Germany
| | - Bettina Zinngrebe
- Department of Hematology, Oncology and Palliative Care, Evangelisches Krankenhaus, Bielefeld, Germany
| | - Gerald Meckenstock
- Department of Medical Oncology, Radiooncology, Hematology and Palliative Care, St. Josef Hospital, Gelsenkirchen, Germany
| | - Eva Roemer
- Department of Hematology and Oncology, Klinikum Idar-Oberstein, Idar-Oberstein, Germany
| | - Dirk Medgenberg
- Department of Medicine III, Klinikum Leverkusen, Leverkusen, Germany
| | | | - Gero Massenkeil
- Department of Medicine II, Klinikum Gütersloh, Gütersloh, Germany
| | - Heidrun Hindahl
- Department of Medicine I, St. Johannes Hospital, Dortmund, Germany
| | - Rainer Schwerdtfeger
- Department for Bone Marrow and Blood Stem Cell Transplantation, DKD Deutsche Klinik für Diagnostik, Wiesbaden, Germany
| | - Guido Trenn
- Department of Medicine I, Knappschaftskrankenhaus, Bottrop, Germany
| | - Cristina Sauerland
- Insitute for Biostatistics and Clinical Research, University Hospital, Münster, Germany
| | - Raphael Koch
- Insitute for Biostatistics and Clinical Research, University Hospital, Münster, Germany
| | - Martin Lablans
- Insitute for Biostatistics and Clinical Research, University Hospital, Münster, Germany.,Division of Medical Informatics in Translational Oncology, DKFZ German Cancer Research Center, Heidelberg, Germany
| | - Andreas Faldum
- Insitute for Biostatistics and Clinical Research, University Hospital, Münster, Germany
| | - Dennis Görlich
- Insitute for Biostatistics and Clinical Research, University Hospital, Münster, Germany
| | - Stefan K Bohlander
- Department of Medicine III, University Hospital LMU Campus Grosshadern, Munich, Germany.,Department of Molecular Medicine and Pathology, University of Auckland, Auckland, New Zealand
| | - Stephanie Schneider
- Department of Medicine III, University Hospital LMU Campus Grosshadern, Munich, Germany
| | - Annika Dufour
- Department of Medicine III, University Hospital LMU Campus Grosshadern, Munich, Germany
| | - Christian Buske
- Department of Medicine III, University Hospital LMU Campus Grosshadern, Munich, Germany.,Institute of Experimental Cancer Research, University Hospital, Ulm, Germany
| | - Michael Fiegl
- Department of Medicine III, University Hospital LMU Campus Grosshadern, Munich, Germany
| | - Marion Subklewe
- Department of Medicine III, University Hospital LMU Campus Grosshadern, Munich, Germany
| | - Birgit Braess
- Department of Oncology and Hematology, Hospital Barmherzige Brüder, Regensburg, Germany.,Department of Medicine III, University Hospital LMU Campus Grosshadern, Munich, Germany
| | - Michael Unterhalt
- Department of Medicine III, University Hospital LMU Campus Grosshadern, Munich, Germany
| | - Anja Baumgartner
- Department of Medicine III, University Hospital LMU Campus Grosshadern, Munich, Germany
| | | | - Dietrich Beelen
- Department of Bone Marrow Transplantation, University Hospital, Essen, Germany
| | - Wolfgang Hiddemann
- Department of Medicine III, University Hospital LMU Campus Grosshadern, Munich, Germany
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Kayser S, Benner A, Thiede C, Martens U, Huber J, Stadtherr P, Janssen JWG, Röllig C, Uppenkamp MJ, Bochtler T, Hegenbart U, Ehninger G, Ho AD, Dreger P, Krämer A. Pretransplant NPM1 MRD levels predict outcome after allogeneic hematopoietic stem cell transplantation in patients with acute myeloid leukemia. Blood Cancer J 2016; 6:e449. [PMID: 27471865 PMCID: PMC5030374 DOI: 10.1038/bcj.2016.46] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Accepted: 05/19/2016] [Indexed: 12/19/2022] Open
Abstract
The objective was to evaluate the prognostic impact of pre-transplant minimal residual disease (MRD) as determined by real-time quantitative polymerase chain reaction in 67 adult NPM1-mutated acute myeloid leukemia patients receiving allogeneic hematopoietic stem cell transplantation (HSCT). Twenty-eight of the 67 patients had a FLT3-ITD (42%). Median age at transplantation was 54.7 years, median follow-up for survival from time of allografting was 4.9 years. At transplantation, 31 patients were in first, 20 in second complete remission (CR) and 16 had refractory disease (RD). Pre-transplant NPM1 MRD levels were measured in 39 CR patients. Overall survival (OS) for patients transplanted in CR was significantly longer as compared to patients with RD (P=0.004), irrespective of whether the patients were transplanted in first or second CR (P=0.74). There was a highly significant difference in OS after allogeneic HSCT between pre-transplant MRD-positive and MRD-negative patients (estimated 5-year OS rates of 40 vs 89% P=0.007). Multivariable analyses on time to relapse and OS revealed pre-transplant NPM1 MRD levels >1% as an independent prognostic factor for poor survival after allogeneic HSCT, whereas FLT3-ITD had no impact. Notably, outcome of patients with pre-transplant NPM1 MRD positivity >1% was as poor as that of patients transplanted with RD.
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Affiliation(s)
- S Kayser
- Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany.,Clinical Cooperation Unit Molecular Hematology/Oncology, German Cancer Research Center (DKFZ) and Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany
| | - A Benner
- Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - C Thiede
- Department of Medicine I, University Hospital Carl-Gustav-Carus, Dresden, Germany
| | - U Martens
- Cancer Center Heilbronn-Franken, Heilbronn, Germany
| | - J Huber
- Cancer Center Heilbronn-Franken, Heilbronn, Germany
| | - P Stadtherr
- Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany
| | - J W G Janssen
- Institute of Human Genetics, University of Heidelberg, Heidelberg, Germany
| | - C Röllig
- Department of Medicine I, University Hospital Carl-Gustav-Carus, Dresden, Germany
| | - M J Uppenkamp
- Department of Oncology, Hospital of Ludwigshafen, Ludwigshafen, Germany
| | - T Bochtler
- Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany.,Clinical Cooperation Unit Molecular Hematology/Oncology, German Cancer Research Center (DKFZ) and Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany
| | - U Hegenbart
- Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany
| | - G Ehninger
- Department of Medicine I, University Hospital Carl-Gustav-Carus, Dresden, Germany
| | - A D Ho
- Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany
| | - P Dreger
- Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany
| | - A Krämer
- Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany.,Clinical Cooperation Unit Molecular Hematology/Oncology, German Cancer Research Center (DKFZ) and Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany
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