Impact of Remission Induction Chemotherapy Prior to Allogeneic SCT in Relapsed and Poor-response Patients With AML

Inclusion Criteria

* Signed written informed consent.
* Male and female patients of 18 to 75 years of age.
* Diagnosis of AML according to WHO criteria.
* Patient is fit for aggressive induction chemotherapy and transplantation by assessment of an experienced hematologist.
* No history of chronic pulmonary disease and absence of dyspnea. Otherwise, documented diffusion lung capacity for carbon monoxide ( DLCO ) ≤ 40 percent ( adjusted for hemoglobin, if available ) and FEV1 / FVC ≥ 50 percent.
* HLA - identical sibling. or
* HLA - compatible unrelated donor ( ≥ 9 /10 antigens matched for HLA - A, - B, - C, -DRB 1, and - DQB 1 ) with completed confirmatory typing or
* Two unrelated donors with \> 90 percent probability of a 9 /10 match for HLA - A, - B, - C, - DRB 1, and - DRQB 1, according to Opti Match ® list.

For the relapse stratum

* First AML relapse, defined as ≥ 5 percent bone marrow blasts and / or extramedullary AML manifestation.

For the poor - responders stratum

* AML that evolves from previously documented myelodysplastic syndrome ( MDS ),

and / or

* diagnosis of therapy-related myeloid neoplasm ( t - MN ), and / or

a ) If patient ≤ 60 years old adverse risk AML according to ELN - criteria and ≥ 5 percent bone marrow blasts after the first cycle of induction therapy.

b ) If patient \> 60 years old non-favourable risk AML according to ELN - criteria and ≥ 5 percent bone marrow blasts after the first cycle of induction therapy.

Exclusion Criteria

* Acute promyelocytic leukemia ( APL ).
* WBC count of ≥ 50 GPt / L at study inclusion.
* For patients in the poor - responder stratum the first cycle of induction therapy must not contain HDAC, defined as cytarabine at single-doses of \> 1 g / m 2.
* Patient has received more than 440 mg / m2 daunorubicin equivalents.
* Severe organ dysfunction, defined as
* Left ventricular ejection fraction \< 50 percent.
* Patients who receive supplementary continuous oxygen.
* Serum bilirubin \> 1.5 x ULN ( if not considered Gilbert-Syndrome ), ASAT / ALAT \> 5 x ULN.
* Estimated GFR \< 50 ml / min.
* Treatment with any investigational drug within 10 days before study entry.
* Uncontrolled infection at the time of enrollment.
* History of allogeneic transplantation.
* Manifestation of AML in the central nervous system.
* Pregnant or breast - feeding women.
* Men unable or unwilling to use adequate contraception methods from start of study treatment to minimum of six months after the last dose of chemotherapy.
* Women of childbearing potential except those who fulfill the following criteria: Post-menopausal or post-operative or continuous and correct application of a contraception method with a Pearl Index \< 1 percent or sexual abstinence or vasectomy of the sexual partner.