Présentation PowerPoint - Comtecmed
Transcript of Présentation PowerPoint - Comtecmed
Allogeneic SCT for refractory LeukemiaYES or NO?
Pr. Didier Blaise, MDCOSTEM 2011, Berlin, September 9th – 11th
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
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%
• 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!
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