Abstract
<h3>Context:</h3> Relapsed/refractory (R/R) acute myeloid leukemia (AML) patients have very poor prognosis. Myeloablative conditioning followed by allogeneic hematopoietic cell transplantation (allo-HCT) remains the only option to achieve disease control in such high-risk patients. <h3>Objective:</h3> The aim of this study is to evaluate the efficacy and safety of myeloablative conditioning followed by allo-HCT in patients with R/R AML in active disease. <h3>Design:</h3> This is a single center, observational, retrospective study of patients diagnosed with R/R AML (2016-2020) and treated at the American University of Beirut Medical Center in Lebanon. <h3>Main Outcome Measures:</h3> Data regarding patient baseline characteristics, disease-related factors, transplant outcomes, and complications were collected. <h3>Results:</h3> We identified 16 patients with R/R AML who underwent allo-HCT in active disease, with median three lines of treatments. The median age at transplant was 49 years (range 33-75). Of them, 8 (50%) were males, 9 (56%) had high-risk ELN, 12 (75%) had haploidentical donors and 4 (25%) had full matched related donors. Thirteen (81%) patients received sequential conditioning, two (13%) received clofarabine with total body irradiation, and one (6%) received fludarabine and busulfan. Fourteen (87%) patients received anti-thymocyte globulin. Neutrophil and platelet engraftment were seen in 14 (88%) and 9 (56%) patients, respectively. At day 30 post-allo-HCT, 11 (68%) patients had complete remission (CR). At day 100, 10 (63%) patients were alive, 7 out of them (44%) were disease free with full donor chimerism. After a median follow-up of 5.3 months (range 0.2 – 27.5) post-allo-HCT, the median overall survival was 2.9 months (range 0.3-27.5), with active leukemia being the primary cause of death (62%), only four patients (25%) died from transplant related complications. Univariate analysis of factors affecting OS showed improved survival in patients receiving post-allo HCT 5-azacitidine and donor lymphocyte infusion (p= 0.035 and p=0.0341, respectively). Three patients (19%) developed acute GVHD and one of them died due to its complications. CMV and EBV reactivations were seen in 38% and 6% of cases. <h3>Conclusion:</h3> Myeloablative conditioning followed by allo-HCT for patients with R/R AML in active disease can confer a disease control in a subset of patients, with acceptable rate of transplant-related mortality.
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