Long-term results of reduced-intensity conditioning allogeneic hematopoietic cell transplantation for older patients with acute myeloid leukemia: a retrospective analysis of 10-year follow-up data

2020 ◽  
Vol 55 (10) ◽  
pp. 2008-2016 ◽  
Author(s):  
Masamitsu Yanada ◽  
Takahiro Fukuda ◽  
Masatsugu Tanaka ◽  
Shuichi Ota ◽  
Takashi Toya ◽  
...  
Keyword(s):  
Acute Myeloid Leukemia ◽  
Older Patients ◽  
Myeloid Leukemia ◽  
Hematopoietic Cell Transplantation ◽  
Long Term Results ◽  
Reduced Intensity Conditioning ◽  
Reduced Intensity ◽  
Acute Myeloid

Use of Reduced Intensity Conditioning (RIC) Regimens Are Associated with a Better Outcome with Sibling Donors Transplants in Older Patients (> 50 years) with Acute Myeloid Leukemia (AML)

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 3307-3307 ◽  
Author(s):  
Biju George ◽  
Ian Kerridge ◽  
Gillian Huang ◽  
David J Gottlieb ◽  
Mark Hertzberg ◽  
...  
Keyword(s):  
Acute Myeloid Leukemia ◽  
T Cell ◽  
Older Patients ◽  
Myeloid Leukemia ◽  
Reduced Intensity Conditioning ◽  
Unrelated Donors ◽  
Conditioning Regimens ◽  
Reduced Intensity ◽  
Acute Myeloid

Abstract Reduced intensity conditioning regimens are increasingly been used in patients aged more than 50 years because of the reduced toxicity associated with these regimens. We compared the outcome of myeloablative (MAT) with reduced intensity (RIC) transplants performed at our centre between 1998 and 2008 for patients older than 50 years with acute myeloid leukemia (AML). Twenty five patients with a median age of 53 years (range: 50– 62) underwent MAT while 26 (median age: 56 yrs [range: 50–65] underwent a RIC transplant. Eight patients undergoing MAT and 9 undergoing RIC were in first remission (CR1) (p = 0.843). Unrelated donors were used in 44% of MAT and 40% of RIC transplants. Conditioning regimens used for MAT included combination of either Busulfan (Bu) with Cyclophosphamide (Cy) or Cy with Total Body irradiation (TBI) while RIC consisted of Fludarabine in combination with either Cy[120 mg/kg], Bu [10 mg/kg] or Melphalan (Mel) [140 mg/m2]. Peripheral blood stem cells (PBSC) were the graft source in all RIC and 76% of MAT transplants. T cell depletion with ATG occurred in 13 MAT transplants [11 MUD and 2 single antigen mismatched sibling] while RIC transplants used either ATG (n = 4 [15.3%]) or Campath (n = 6; [23%]) for T cell depletion [10 MUD]. Three patients undergoing MAT transplant expired due to infection on days 12, 15 and 21 with no evidence of engraftment while 22 (88%) engrafted with a median time to ANC > 0.5 x 109/L of 16.1 days (range: 12 – 23). Among RIC, all patients engrafted with a median time to neutrophil engraftment of 15.6 days (range: 10 – 25). The incidence of acute graft versus host disease (GVHD) in patients with sibling donors was 62% in MAT and 50% in RIC (p = 0.296) while in patients with MUD donors, it was 91% with MAT and 40% with RIC (p = 0.013). Grade II–IV GVHD however was not significantly different between MAT (40%) and RIC transplants (30.7%; p =0.49) both for sibling (31% RIC vs 30% MAT p = 0.411) and MUD donors (30% RIC vs 55% MAT; p = 0.256). Day 100 transplant related mortality was 44% among MAT transplants as compared to 19% among RIC transplants (p = 0.05); 6 of the 11 deaths in the MAT arm were due to GVHD (3 sibling, 3 MUD) while 2 out of 5 patients in the RIC arm expired due to GVHD (p = NS). Chronic GVHD was seen in 26% of MAT and 50% of RIC transplants (p = 0.156) Relapses occurred in 4 patients each among MAT and RIC transplants. At a median follow up of 31 months (range: 1 – 85), the overall (OS) and leukemia free survival (LFS) for MAT transplants were 28% and 24% respectively and for RIC transplants 65% and 54% (p <0.01 and 0.02 respectively). This difference remained significant for patients with sibling donors [OS -75% with RIC vs 21.4% with MAT (p = 0.003); LFS 62.5% with RIC and 7.1% with MAT (p = 0.002)] but not for those with MUD donors [OS - 50% with RIC vs 36.3% with MAT (p = 0.528); LFS 40% with RIC and 36.3% with MAT (p = 0.279)]. The median follow up among survivors was 40.4 months (range: 3 – 85) for the MAT transplants and 39.2 months (range: 5 – 85) for RIC. The use of RIC regimens is associated with a superior survival in older patients with AML with a sibling donor and with equivalent survival in patients with a MUD donor. A larger number of patients need to be studied to ensure that RIC transplants are not inferior to MAT transplants for older AML patients with unrelated donors. Until then, RIC transplants should be recommended for those over 50 years with AML undergoing allogeneic stem cell transplantation.

scholarly journals Reduced intensity conditioning for acute myeloid leukemia using melphalan- vs busulfan-based regimens: a CIBMTR report

2020 ◽  
Vol 4 (13) ◽  
pp. 3180-3190
Author(s):  
Zheng Zhou ◽  
Rajneesh Nath ◽  
Jan Cerny ◽  
Hai-Lin Wang ◽  
Mei-Jie Zhang ◽  
...  
Keyword(s):  
Acute Myeloid Leukemia ◽  
Myeloid Leukemia ◽  
Marrow Transplant ◽  
Reduced Intensity Conditioning ◽  
Related Factors ◽  
Multivariate Survival Model ◽  
Reduced Intensity ◽  
Acute Myeloid

Abstract There is a lack of large comparative study on the outcomes of reduced intensity conditioning (RIC) in acute myeloid leukemia (AML) transplantation using fludarabine/busulfan (FB) and fludarabine/melphalan (FM) regimens. Adult AML patients from Center for International Blood and Marrow Transplant Research who received first RIC allo-transplant between 2001 and 2015 were studied. Patients were excluded if they received cord blood or identical twin transplant, total body irradiation in conditioning, or graft-versus-host disease (GVHD) prophylaxis with in vitro T-cell depletion. Primary outcome was overall survival (OS), secondary end points were leukemia-free survival (LFS), nonrelapse mortality (NRM), relapse, and GVHD. Multivariate survival model was used with adjustment for patient, leukemia, and transplant-related factors. A total of 622 patients received FM and 791 received FB RIC. Compared with FB, the FM group had fewer transplant in complete remission (CR), fewer matched sibling donors, and less usage of anti-thymocyte globulin or alemtuzumab. More patients in the FM group received marrow grafts and had transplantation before 2005. OS was significantly lower within the first 3 months posttransplant in the FM group (hazard ratio [HR] = 1.82, P &lt; .001), but was marginally superior beyond 3 months (HR = 0.87, P = .05). LFS was better with FM compared with FB (HR = 0.89, P = .05). NRM was significantly increased in the FM group during the first 3 months of posttransplant (HR = 3.85, P &lt; .001). Long-term relapse was lower with FM (HR = 0.65, P &lt; .001). Analysis restricted to patients with CR showed comparable results. In conclusion, compared with FB, the FM RIC showed a marginally superior long-term OS and LFS and a lower relapse rate. A lower OS early posttransplant within 3 months was largely the result of a higher early NRM.

Sign in / Sign up

Export Citation Format

Share Document