Feasibility of allogeneic stem cell transplantation (HSCT) in patients with acute myeloid leukemia previously treated with CPX-351: report from a single center

The increased use of CPX-351, a liposomal formulation of cytarabine and daunorubicin, in association with reduced intensity conditioning regimen and new strategies of GvHD prophylaxis such as PTCY, allows to proceed with HSCT in older patients or previously heavily treated, improving outcomes. Of 55 patients with s-AML treated with CPX-351 from February 2019 till December 2023, at our center, all 28 patients with an indication to proceed with HSCT, underwent to transplant to consolidate the obtained response. The median age was 62 yrs (range 43–69). They were all in complete remission except two. The median HCT-CI was 4 (range 0–7). The main conditioning regimen was the association of Thiotepa, Busulfan, and Fludarabine. A Prophylaxis Gvhd regimen was performed with cyclosporine and mycophenolic acid, and PTCY. Engraftment was reached in all patients treated with CPX-351, except one. Eight patients developed acute GVHD. 1 year’s OS was 66%. Comparing data with 59 patients, previously treated with 7 + 3 standard induction therapy, we found differences in terms of median age (p < 0.00001), HCT-CI (p = 0.01), and in terms of median CD34 + stem cells, which are significantly higher in the younger comparison population (p = 0.0002), with similar outcomes. The growing use of CPX-351 appears to be a safe and effective bridge therapy for HSCT in patients with a poorer prognosis, reproducing outcomes similar to younger populations.