Allogeneic stem cell transplantation (allo-SCT) represents the most beneficial treatment for patients with active relapsed/refractory (R/R) hematologic malignancies. Recently, sequential regimens combining debulking chemotherapy followed by reduced-intensity conditioning (RIC) have shown encouraging results for these patients. In this retrospective study, we report the extended results of a sequential regimen of clofarabine, cytosine arabinoside, and RIC in 131 adults with active R/R myeloid disease at transplant. Conditioning consisted of clofarabine (30 mg/m²/day) and cytosine arabinoside (1 g/m²/day) for 5 days, followed, after a rest of 3 days, by an RIC combining cyclophosphamide (60 mg/kg) for 1 day, iv busulfan (3.2 mg/kg/day) for 2 days, and anti-thymocyte globulin (2.5 mg/kg/day) for 2 days. Between 2007 and 2016, 131 patients (males n = 75, median age: 52.6 years) were identified from the SFGM-TC registry. There were 111 acute myeloid leukemia (AML) patients and 20 cases with myelodysplastic or myeloproliferative syndrome. Status at transplant was known for all but 4 patients and was primary refractory (n = 81) and 1st or 2nd relapse (n = 46). All patients received allo-SCT from a matched donor (sibling n = 64, unrelated n = 67). Engraftment was observed in 105/122 (86%) evaluable cases and 63% of the patients achieved complete remission (CR) after transplant. The 1-year overall survival, disease-free survival, relapse incidence, non-relapse mortality, and graft-versus-host disease-free/relapse-free survival were 39.2%, 28.1%, 41.0%, 30.8%, and 22.2%, respectively. This study confirms that this sequential clofarabine-based regimen provides a high CR rate in this critical population, although relapse remains a matter of concern.

同种异体干细胞移植（allo-SCT）是活动性复发/难治性（R / R）血液系统恶性肿瘤患者的最有益治疗。最近，相继的方案结合了减量化疗和降低强度的调节（RIC）对这些患者显示出令人鼓舞的结果。在这项回顾性研究中，我们报道了氯法拉滨，胞嘧啶阿拉伯糖苷和RIC序贯治疗方案在131名具有活跃R / R髓样疾病的成年人中的扩展治疗结果。调理包括氯法拉滨（30 mg / m ² /天）和胞嘧啶阿拉伯糖苷（1 g / m ^2）/天），持续5天，然后在休息3天后，进行RIC结合环磷酰胺（60 mg / kg）持续1天，静脉使用白消安（3.2 mg / kg /天）持续2天和抗胸腺细胞球蛋白（2.5 mg / kg / day）2天。在2007年至2016年之间， 从SFGM-TC注册中心中识别出131例患者（男性n = 75，中位年龄：52.6岁）。有111例急性髓细胞白血病（AML）患者和20例骨髓增生异常或骨髓增生综合征。除4例患者外，其他所有患者都知道移植时的状态，其为原发性难治性（n  = 81）和第一次或第二次复发（n  = 46）。所有患者均从匹配的供者处接受了allo-SCT（同胞n  = 64，无关n = 67）。在105/122（86％）的可评估病例中观察到了移植，移植后63％的患者实现了完全缓解（CR）。1年总生存期，无病生存期，复发率，非复发死亡率以及移植物抗宿主病无病/无复发生存期分别为39.2％，28.1％，41.0％，30.8％和22.2％ ， 分别。这项研究证实，尽管复发仍是一个值得关注的问题，但这种以氯法拉滨为基础的连续治疗方案在这一关键人群中具有较高的CR率。