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

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

Abstract

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.

Conflict of interest statement

CONFLICT OF INTEREST: None

Figures

Figure 1
Figure 1
Cumulative incidence of (a) acute and (b) chronic GVHD after peripheral blood stem cell or bone marrow allogeneic transplant for AML or MDS, by conditioning regimen.
Figure 1
Figure 1
Cumulative incidence of (a) acute and (b) chronic GVHD after peripheral blood stem cell or bone marrow allogeneic transplant for AML or MDS, by conditioning regimen.
Figure 2
Figure 2
Cumulative incidence of (a) treatment-related mortality and (b) relapse after peripheral blood stem cell or bone marrow allogeneic transplant for AML or MDS, by conditioning regimen.
Figure 2
Figure 2
Cumulative incidence of (a) treatment-related mortality and (b) relapse after peripheral blood stem cell or bone marrow allogeneic transplant for AML or MDS, by conditioning regimen.
Figure 3
Figure 3
Adjusted probability of (a) disease-free and (b) overall survival after peripheral blood stem cell or bone marrow allogeneic transplant for AML or MDS, by conditioning regimen.
Figure 3
Figure 3
Adjusted probability of (a) disease-free and (b) overall survival after peripheral blood stem cell or bone marrow allogeneic transplant for AML or MDS, by conditioning regimen.

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Source: PubMed

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