Journal Article

Similar outcomes using myeloablative vs reduced-intensity allogeneic transplant preparative regimens for AML or MDS

Giralt, S A, Bornhauser, M, Hale, G A, Luger, S M, Ringdén, O, Lazarus, H M, Gupta, V, Pérez, W S, Cairo, M S, Lill, M C, McCarthy, P L, Copelan, E A, Bishop, M R, Weisdorf, D J, Zhang, M-J, Bredeson, C N, Gale, R P, Pulsipher, M A, Lewis, V A, Gulbas, Z

2012

Overview

Although reduced-intensity conditioning (RIC) and non-myeloablative (NMA)-conditioning regimens have been used for over a decade, their relative efficacy vs myeloablative (MA) approaches to allogeneic hematopoietic cell transplantation in patients with AML and myelodysplasia (MDS) is unknown. We compared disease status, donor, graft and recipient characteristics with outcomes of 3731 MA with 1448 RIC/NMA procedures performed at 217 centers between 1997 and 2004. The 5-year univariate probabilities and multivariate relative risk outcomes of relapse, TRM, disease-free survival (DFS) and OS are reported. Adjusted OS at 5 years was 34, 33 and 26% for MA, RIC and NMA transplants, respectively. NMA conditioning resulted in inferior DFS and OS, but there was no difference in DFS and OS between RIC and MA regimens. Late TRM negates early decreases in toxicity with RIC and NMA regimens. Our data suggest that higher regimen intensity may contribute to optimal survival in patients with AML/MDS, suggesting roles for both regimen intensity and graft vs leukemia in these diseases. Prospective studies comparing regimens are needed to confirm this finding and determine the optimal approach to patients who are eligible for either MA or RIC/NMA conditioning.

• Publisher: Nature Publishing Group UK,Nature Publishing Group
• Subject: Acute myeloid leukemia / Adolescent / Adult / Aged / Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy / Biological and medical sciences / Bone marrow / Bone marrow, stem cells transplantation. Graft versus host reaction / Cell Biology / Conditioning / Disease-Free Survival / Female / Graft-versus-host reaction / Hematologic and hematopoietic diseases / Hematology / Hematopoietic Stem Cell Transplantation - methods / Hematopoietic stem cells / Humans / Internal Medicine / Leukemia / Leukemia, Myeloid, Acute - surgery / Leukemia, Myeloid, Acute - therapy / Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis / Male / Medical sciences / Medicine / Medicine & Public Health / Middle Aged / Myelodysplastic syndrome / Myelodysplastic Syndromes - surgery / Myelodysplastic Syndromes - therapy / original-article / Public Health / Stem cell transplantation / Stem Cells / Survival / Toxicity / Transfusions. Complications. Transfusion reactions. Cell and gene therapy / Transplantation / Transplantation Conditioning - methods / Transplantation, Homologous / Transplants / Transplants & implants / Treatment Outcome / Young Adult