Schuler, Esther and Wagner-Drouet, Eva-Maria and Ajib, Salem and Bug, Gesine and Crysandt, Martina and Dressler, Sabine and Hausmann, Andreas and Heidenreich, Daniela and Hirschbuehl, Klaus and Hoepting, Matthias and Jost, Edgar and Kaivers, Jennifer and Klein, Stefan and Koldehoff, Michael and Kordelas, Lambros and Kriege, Oliver and Mueller, Lutz P. and Rautenberg, Christina and Schaffrath, Judith and Schmid, Christoph and Wolff, Daniel and Haas, Rainer and Bornhaeuser, Martin and Schroeder, Thomas and Kobbe, Guido (2021) Treatment of myeloid malignancies relapsing after allogeneic hematopoietic stem cell transplantation with venetoclax and hypomethylating agents-a retrospective multicenter analysis on behalf of the German Cooperative Transplant Study Group. ANNALS OF HEMATOLOGY, 100. pp. 959-968. ISSN 0939-5555, 1432-0584
Full text not available from this repository. (Request a copy)Abstract
Treatment of relapse after allogeneic hematopoietic stem cell transplantation (alloHSCT) remains a great challenge. Aiming to evaluate the combination of venetoclax and hypomethylating agents (HMAClax) for the treatment of relapse of myeloid malignancies after alloHSCT, we retrospectively collected data from 32 patients treated at 11 German centers. Venetoclax was applied with azacitidine (n = 13) or decitabine (n = 19); 11 patients received DLI in addition. HMAClax was the first salvage therapy in 8 patients. The median number of cycles per patient was 2 (1-19). All but 1 patient had grade 3/4 neutropenia. Hospital admission for grade 3/4 infections was necessary in 23 patients (72%); 5 of these were fatal. In 30 evaluable patients, overall response rate (ORR) was 47% (14/30, 3 CR MRDneg, 5 CR, 2 CRi, 1 MLFS, 3 PR). ORR was 86% in first salvage patients versus 35% in later salvage patients (p = 0.03). In 6 patients with molecular relapse (MR), ORR was 67% versus 42% in patients with hematological relapse (HR) (n = 24, p = n.s.). After a median follow-up of 8.4 months, 25 patients (78%) had died and 7 were alive. Estimated median overall survival was 3.7 months. Median survival of patients with HMAClax for first versus later salvage therapy was 5.7 and 3.4 months (p = n.s.) and for patients with MR (not reached) compared to HR (3.4 months, p = 0.024). This retrospective case series shows that venetoclax is utilized in various different combinations, schedules, and doses. Toxicity is substantial and patients who receive venetoclax/HMA combinations for MR or as first salvage therapy derive the greatest benefit.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | CONSENSUS DEVELOPMENT PROJECT; DONOR LYMPHOCYTE INFUSIONS; VERSUS-HOST-DISEASE; WORKING GROUP; MYELODYSPLASTIC SYNDROME; CLINICAL ACTIVITY; LEUKEMIA; AZACITIDINE; DIAGNOSIS; AML; Allogeneic hematopoietic stem cell transplantation; Relapse; Venetoclax; Hypomethylating agents; Azacitidine; Decitabine; DLI |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Innere Medizin III (Hämatologie und Internistische Onkologie) |
| Depositing User: | Petra Gürster |
| Date Deposited: | 21 Apr 2021 08:34 |
| Last Modified: | 21 Apr 2021 08:34 |
| URI: | https://pred.uni-regensburg.de/id/eprint/43368 |
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