Participants: Dr Liga, Dr Tsokanas, Dr Valera, Zoi Panagi (Pharmassist)
Presenter: Prof. Spyridonidis
Duration: 40 mins

Therapeutic options for patients with AML relapsing after allogeneic HCT range from chemotherapy or hypomethylating agents
with or without donor lymphocyte infusions to a 2nd allogeneic HCT. Available data are based on retrospective single center or
registry studies. The aim of this multicenter trial was to investigate prospectively intensive conditioning with Thiotepa, Fludarabine
and Treosulfan (TFT) for 2nd allogeneic HCT from an alternative unrelated donor in patients with AML relapse > 6 months after a 1st
allogeneic HCT. Primary endpoint was disease-free survival (DFS) at one year after 2nd HCT. 50 patients median age 53.5 years, in
CR/PR (34%) or active relapse (66%) were included. 33 of 38 patients (86.8%) with available data achieved CR 100 days post
transplant. 23 patients were alive and free of relapse at primary endpoint one year after 2nd HCT (DFS rate 0.46, 95%-CI (0.32–0.61).
Three-year rates of DFS, relapse, non-relapse mortality, and overall survival were 0.24, 95%-CI (0.13–0.36); 0.36 (0.25–0.52); 0.40
(0.29–0.57); and 0.24 (0.13–0.37). Second HCT with TFT conditioning is feasible and has high anti-leukemic efficacy in
chemosensitive or refractory AML relapse after prior allogeneic HCT. Still, relapse rates and NRM after 2nd allogeneic HCT remain a
challenge. The trial is registered in the German Clinical Trials Registry (number DRKS00005126).