Tandem Allogeneic Hematopoietic Stem Cell Transplantation for Salvage Treatment of Acute Myeloid Leukemia Refractory to Induction Chemotherapy: A Case Report

• Published in: Transplantation proceedings Vol. 52; no. 8; pp. 2548 - 2550
• Main Authors: Drozd-Sokolowska, Joanna, Dwilewicz-Trojaczek, Jadwiga, Tormanowska, Magdalena, Karakulska-Prystupiuk, Ewa, Sachs, Wojciech, Halaburda, Kazimierz, Urbanowska, Elzbieta, Gierej, Beata, Basak, Grzegorz W., Wiktor-Jedrzejczak, Wieslaw
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.2020
• Subjects: Adult; Busulfan - administration & dosage; Cladribine - administration & dosage; Cyclophosphamide - administration & dosage; Cytarabine - administration & dosage; Female; Hematopoietic Stem Cell Transplantation - methods; Humans; Induction Chemotherapy; Leukemia, Myeloid, Acute - therapy; Melphalan - administration & dosage; Mitoxantrone - administration & dosage; Salvage Therapy - methods; Transplantation Conditioning - methods
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2020.01.124

Primary refractory acute myeloid leukemia (AML) is associated with dismal prognosis. No standard treatment options are available, and it remains an unmet clinical need. Here, we report a case of a tandem allogeneic hematopoietic stem cell transplantation (allo-HSCT) performed in a patient who did not achieve remission after 2 courses of induction chemotherapy. The treatment was approved by the Bioethical Commission of the Medical University of Warsaw and was performed in accordance with the Declaration of Helsinki. The patient gave informed consent. A 41-year-old woman was diagnosed with AML, high cytogenetic risk, with concomitant skin and central nervous system involvement, bone marrow necrosis, and hemophagocytic lymphohistiocytosis. She received “3+7” induction and HAM (cytarabine, mitoxantrone) reinduction, after which she did not achieve remission and hematopoietic recovery. Tandem allo-HSCT was performed from the same HLA-identical brother---the first after reduced intensity conditioning (cladribine, cytarabine, mitoxantrone, melphalan) and the second after myeloablative conditioning (BuCy--busulphan, cyclophosphamide). The patient obtained complete remission after the first allo-HSCT and remains disease-free after the second for 5 years Tandem allo-HSCT may be a treatment option for primary refractory AML. •Primary refractory acute myeloid leukemia is associated with a dismal prognosis.•As no standard treatment options are available, it remains an unmet clinical need.•Tandem allogeneic hematopoietic stem cell transplantation may be an option.