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.