P-777 Comparison of GnRH-a trigger and GnRH-a plus low-dose HCG trigger for high ovarian responders in IVF/ICSI: A retrospective study based on propensity score matching

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Y Li
Keyword(s):  
Propensity Score ◽  
Propensity Score Matching ◽  
Pregnancy Outcome ◽  
Low Dose ◽  
Ovarian Response ◽  
Cumulative Live Birth Rate ◽  
Group A ◽  
Low Dose Hcg ◽  
High Responders ◽  
Severe Ohss

Abstract Study question Does GnRH agonist trigger for high responders during IVF/ICSI cycles improve the number of good-quality embryos, the incidence of moderate-to-severe OHSS, and pregnancy outcome compared to GnRH-a plus low-dose HCG? Summary answer GnRH-a trigger alone can effectively reduce the incidence of moderate-to-severe OHSS in women with high ovarian responses without affecting embryo quality. What is known already Previous studies have shown conflicting results on the different trigger protocol in high responders in IVF/ICSI outcomes, and as for women with high ovarian response, there is little known about the effects of GnRH-a plus low-dose HCG versus GnRH-a alone on oocytes maturation, the rate of good quality embryos, the incidence of moderate-to-severe OHSS, and pregnancy outcome during IVF/ICSI cycles. Study design, size, duration A retrospective analysis was conducted on patients with high ovarian response who received IVF/ICSI treatment with a flexible GnRH antagonist regimen, at the Center of Reproductive Medicine, Chengdu Jinjiang Hospital for Maternal and Child Health Care, from January 1 2017 to December 31 2018. Using 1:1 propensity score matching, 513 cases entered each group (a total of 1,026 females). Participants/materials, setting, methods The high responders were included and assigned to groups A (0.2 mg triptorelin) and B (0.2 mg triptorelin plus 2000 IU HCG) for final oocyte maturation. Their basic clinical characteristics, information about controlled ovarian stimulation cycle, embryologic data, and pregnancy outcome in FET were retrospectively compared. The main outcome measures of the study were the rate of good-quality embryos, the number of available embryos, the incidence of moderate-to-severe OHSS, and the cumulative live-birth rate. Main results and the role of chance Using 1:1 propensity score matching, 513 females were included in each group. No significant differences in baseline clinical data were found between the two groups, including age at diagnosis, spouse’s age, the duration of infertility, the infertility type, and the cause of infertility, BMI, anti-Müllerian hormone (AMH) levels, and the antral follicle count (AFC) (p > 0.05). None significant differences were found in the total doses of gonadotropin (Gn), the duration of ovarian stimulation, serum P and LH levels on the trigger day, the number of oocytes retrieved, the rate of 2PN embryos, and the rate of good-quality embryos (p > 0.05). The serum E2 level on the trigger day in group A was significantly higher than that in group B (p < 0.001). Women in group A had a lower incidence rate of moderate-to-severe OHSS than individuals in group B (p < 0.001). There was a non-significant difference in the cumulative live-birth rate between the two groups (p > 0.05). Limitations, reasons for caution As this is a retrospective study that uses data initially collected for other purposes, limitations may exist in the selection, implementation, and measurement biases that cannot be avoided. However, our study underlies the need for further prospective, multi-center joint-controlled studies to validate these findings. Wider implications of the findings This study demonstrates that GnRH-a alone can reduce the incidence of moderate-to-severe OHSS without harming embyro quality in women with high ovarian response. These findings need further prospective validations in hyperresponsive populations by multi-center, large-sample, randomized controlled studies. Trial registration number N/A

P–777 Comparison of GnRH-a trigger and GnRH-a plus low-dose HCG trigger for high ovarian responders in IVF/ICSI: A retrospective study based on propensity score matching

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Y Li
Keyword(s):  
Propensity Score ◽  
Propensity Score Matching ◽  
Pregnancy Outcome ◽  
Low Dose ◽  
Ovarian Response ◽  
Cumulative Live Birth Rate ◽  
Group A ◽  
Low Dose Hcg ◽  
High Responders ◽  
Severe Ohss

Abstract Study question Does GnRH agonist trigger for high responders during IVF/ICSI cycles improve the number of good-quality embryos, the incidence of moderate-to-severe OHSS, and pregnancy outcome compared to GnRH-a plus low-dose HCG? Summary answer GnRH-a trigger alone can effectively reduce the incidence of moderate-to-severe OHSS in women with high ovarian responses without affecting embryo quality. What is known already Previous studies have shown conflicting results on the different trigger protocol in high responders in IVF/ICSI outcomes, and as for women with high ovarian response, there is little known about the effects of GnRH-a plus low-dose HCG versus GnRH-a alone on oocytes maturation, the rate of good quality embryos, the incidence of moderate-to-severe OHSS, and pregnancy outcome during IVF/ICSI cycles. Study design, size, duration A retrospective analysis was conducted on patients with high ovarian response who received IVF/ICSI treatment with a flexible GnRH antagonist regimen, at the Center of Reproductive Medicine, Chengdu Jinjiang Hospital for Maternal and Child Health Care, from January 1 2017 to December 31 2018. Using 1:1 propensity score matching, 513 cases entered each group (a total of 1,026 females). Participants/materials, setting, methods The high responders were included and assigned to groups A (0.2 mg triptorelin) and B (0.2 mg triptorelin plus 2000 IU HCG) for final oocyte maturation. Their basic clinical characteristics, information about controlled ovarian stimulation cycle, embryologic data, and pregnancy outcome in FET were retrospectively compared. The main outcome measures of the study were the rate of good-quality embryos, the number of available embryos, the incidence of moderate-to-severe OHSS, and the cumulative live-birth rate. Main results and the role of chance Using 1:1 propensity score matching, 513 females were included in each group. No significant differences in baseline clinical data were found between the two groups, including age at diagnosis, spouse’s age, the duration of infertility, the infertility type, and the cause of infertility, BMI, anti-Müllerian hormone (AMH) levels, and the antral follicle count (AFC) (p > 0.05). None significant differences were found in the total doses of gonadotropin (Gn), the duration of ovarian stimulation, serum P and LH levels on the trigger day, the number of oocytes retrieved, the rate of 2PN embryos, and the rate of good-quality embryos (p > 0.05). The serum E2 level on the trigger day in group A was significantly higher than that in group B (p < 0.001). Women in group A had a lower incidence rate of moderate-to-severe OHSS than individuals in group B (p < 0.001). There was a non-significant difference in the cumulative live-birth rate between the two groups (p > 0.05). Limitations, reasons for caution As this is a retrospective study that uses data initially collected for other purposes, limitations may exist in the selection, implementation, and measurement biases that cannot be avoided. However, our study underlies the need for further prospective, multi-center joint-controlled studies to validate these findings. Wider implications of the findings: This study demonstrates that GnRH-a alone can reduce the incidence of moderate-to-severe OHSS without harming embyro quality in women with high ovarian response. These findings need further prospective validations in hyperresponsive populations by multi-center, large-sample, randomized controlled studies. Trial registration number N/A

scholarly journals Effect of GnRH Agonist Alone or Combined With Different Low-dose hCG on Cumulative Live Birth Rate for High Responders in GnRH Antagonist Cycles: a Retrospective Study

2021 ◽  
Author(s):  
Yuxia He ◽  
Yan Tang ◽  
Shiping Chen ◽  
Jianqiao Liu ◽  
Haiying Liu
Keyword(s):  
Live Birth ◽  
Oocyte Maturation ◽  
Low Dose ◽  
Live Birth Rate ◽  
Cumulative Live Birth Rate ◽  
Oocyte Maturity ◽  
Cumulative Live Birth ◽  
Group A ◽  
Group B ◽  
High Responders

Abstract Background: There is insufficient evidence regarding the impact of dual trigger on oocyte maturity and reproductive outcomes in high responders. Thus, we aimed to explore the effect of gonadotropin-releasing hormone agonist (GnRHa) trigger alone or in combination with different low-dose human chorionic gonadotropin (hCG) regimens on rates of oocyte maturation and cumulative live birth in high responders who underwent a freeze-all strategy in GnRH antagonist cycles.Methods: A total of 1343 cycles were divided into three groups according to different trigger protocols: group A received GnRHa 0.2 mg (n=577), group B received GnRHa 0.2 mg and hCG 1000 IU (n=403), and group C received GnRHa 0.2 mg and hCG 2000 IU (n=363). Results: There were no significant differences in age, body mass index, and rates of oocyte maturation, fertilization, available embryo, and top-quality embryo between the groups. However, the incidence of moderate to severe ovarian hyperstimulation syndrome (OHSS) was significantly different between the three groups (0% in group A, 1.49% in group B, and 1.38% in group C). For the first frozen embryo transfer (FET) cycle, there were no significant differences in the number of transferred embryos and rates of implantation, clinical pregnancy, live birth, and early miscarriage between the three groups. Additionally, the cumulative ongoing pregnancy rate and cumulative live birth rate were not significantly different between the three groups. Similarly, there were no significant differences in gestational age, birth weight, birth height, and the proportion of low birth weight among subgroups stratified by singleton or twin.Conclusions: GnRHa trigger combined with low-dose hCG (1000 IU or 2000 IU) did not improve oocyte maturity and embryo quality and was still associated with an increased risk of moderate to severe OHSS. Therefore, for high responders treated with the freeze-all strategy, the GnRHa single trigger is recommended for final oocyte maturation, which can prevent the occurrence of moderate to severe OHSS and obtain satisfactory pregnancy and neonatal outcomes in subsequent FET cycles.

P–291 Searching for a suitable serum progesterone range at triggering day to achieve optimal cumulative live birth rate in high responders – Which range is better?

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
M J Chen ◽  
C Ya-Fang ◽  
G Hwa-Fen ◽  
Y Yu-Chiao ◽  
K Hsioa-Fan ◽  
...  
Keyword(s):  
Pregnancy Outcome ◽  
Live Birth ◽  
Birth Rate ◽  
Live Birth Rate ◽  
Blastocyst Formation ◽  
Cumulative Live Birth Rate ◽  
Cumulative Live Birth ◽  
Group A ◽  
Group B ◽  
High Responders

Abstract Study question Is there a suitable range of serum progestereone level at triggering day to optimize the cumulative live birth rate (LBR) in high responders? Summary answer Fom the point of view of cLBR, the optimal P4 range for triggering is between 1.5 to 2.5 ng/ml generally and in the high responders. What is known already It is well established that premature progesterone rise (PPR) affect adversely the pregnancy outcome in fresh embryo transfer cycle. It is inferred that PPR alters synchrony between endometrium and the embryos. However, detailed study of the effect of PPR on efficiency of oocyte retrieval , embryo quality and the subsequent cumulative pregnancy outcome is still lacking. Hence we sort to analyze the effect of PPR on the final cumulative LBR in our program especially focused on high responders. Study design, size, duration ART Database in our center was retrospectively reviewed. Total 1523 cycles between 20160101 and 20191231 were recruited under the condition of GnRH antagonist cycle with duration of ovulation induction for more than 5 days and available serum P4 level data on triggering day for data analysis for the relationship between serum P4 value and final cumulative LBRs. Participants/materials, setting, methods Cycles with serum P4 level < 1.5 ng/ml were defined as without PPR (Group A: n = 1383). Cycles with serum P4 level >1.5 were defined as with PPR: P4 between 1.5 and 2.5 as Group B (n = 113), P4 > 2.5 as Group C (n = 27). Those high responding cycles (n = 404) were analyzed similarly and separately as Group A’ (n = 304), B’ (n = 81) and C’(n = 19). The statistics were carried out by SPSS-PC ver. 22.0 with p < 0.05 as statistical significance. Main results and the role of chance Group A had significantly lower number of oocytes (9.8 + 8.0) retrieved as compared to Group B (19.3 + 11.2) and Group C (18.2 + 9.9). However there were no differences in fertilization rate, good embryo rates and BC formation rates between groups. The cumulative LBR (cLBR) were significantly higher in Group B (65.1%) as compared to Group A (40.9%, p < 0.001) and Group C (37.0%, p = 0.008). For the high responding cycles, Group B’ also had marginally significant higher cLBR (75.3%) as compared to group A’(63.8% ; p=0.051) and Group C’ (52.6%; p = 0.050). Comparisons between Group A’ and C revealed significantly less oocytes retrieved but significantly higher blastocyst formation rates in Group A’ and the resultant cLBR were comparable between these two groups. Comparisons between Groups B’ and C’ revealed comparable oocytes retrieved but significant lower blastocyst formation rates and cLBRs in Group C’. The baseline of the first part analysis revealed higher age and lower AMH in Group A, but comparable age and AMH between groups B and C.The lower cLBR in group A could be due to selection bias.The second part (high responders) showed comparable baselines between three groups. However, the case numbers are too few in group C’ which might also result in uncertainty. Limitations, reasons for caution Although the data revealed interesting, significantly different results between groups, this is only a retrospective analysis from our ART patient series. Selection bias could not be precluded. Analysis restricted to high responders could have a more balanced population for comparisons. However, more cases are needed to affirm the findings. Wider implications of the findings: We still do not know the tolerable ceiling of serum P4 at the triggering day in high responders if future FET already planned. Pushing P4 value too high not only could not increase mature oocyte yields and possibly may decrease the number of available good blastocysts for optimizing final cLBRs. Trial registration number Not applicable

scholarly journals Impact of embryo biopsy stage on implantation potential in thalassemias: a propensity score matching study

2019 ◽  
Author(s):  
Yizi Wang ◽  
Chenhui Ding ◽  
Baomin Lu ◽  
Yanhong Zeng ◽  
Xinyan Liu ◽  
...  
Keyword(s):  
Propensity Score ◽  
Propensity Score Matching ◽  
Implantation Rate ◽  
Blastocyst Stage ◽  
Relative Reduction ◽  
Event Analysis ◽  
Cleavage Stage ◽  
Weighted Mean ◽  
Cumulative Live Birth Rate ◽  
The Impact

Abstract Objective: To investigate the impact of biopsy stage on implantation potential of frozen-warmed blastocysts in pre-implantation genetic testing (PGT) cycles for those with thalassemias.Design: Retrospective paired cohort study using propensity score matching (PSM). A time-to-event analysis of Fine-Gray’s analysis was used to compare cumulative live birth rate (CLBR).Setting: Single university-affiliated center .Patient(s): A total of 439 PGT couples were included who underwent PGT for thalassemias between 2015 and 2017.Intervention(s): Two biopsy strategies were evaluated; cleavage-stage biopsy (CB) and blastocyst-stage biopsy (BB).Main Outcome Measure(s): Implantation rate and CLBR.Result(s): A total of 202 ovum pick-up (OPU) cycles from Group CB and 237 OPU cycles from Group BB were included. PSM was conducted for two groups covering characteristics on the OPU cycle and the first frozen-warmed blastocyst transfer (FWBT) cycle , resulting in 140 matched pairs. The implantation rate was significantly lower in the CB group (41.0%, 30.3%, 20.4% in 1st, 2nd and 3rd FWBT cycle respectively, weighted mean 34.2%) than those in the BB group (51.8%, 43.5%, and 40.5% (weighted mean 48.1%), respectively; at P = 0.044, 0.047, 0.039). This was a 28.9% relative reduction ( P = 0.002). The CLBR across three FWBT cycles was significantly higher in the BB group compared with the CB group (80.0% vs. 62.1%, P = 0.032), while the likelihood of LBR was 1.21-fold higher after regression adjustment. Conclusion(s): Cleavage-stage biopsy may partially affect the implantation potential and CLBRs of frozen-warmed blastocysts, compared with blastocyst stage biopsy.

The freeze-all strategy versus agonist triggering with low-dose hCG for luteal phase support in IVF/ICSI for high responders: a randomized controlled trial

2020 ◽  
Vol 35 (12) ◽  
pp. 2808-2818 ◽  
Author(s):  
Samuel Santos-Ribeiro ◽  
Shari Mackens ◽  
Biljana Popovic-Todorovic ◽  
Annalisa Racca ◽  
Nikolaos P Polyzos ◽  
...  
Keyword(s):  
Embryo Transfer ◽  
Gnrh Agonist ◽  
Luteal Phase ◽  
Low Dose ◽  
Pregnancy Rates ◽  
Clinical Pregnancy ◽  
Fresh Embryo Transfer ◽  
Luteal Phase Support ◽  
Low Dose Hcg ◽  
Severe Ohss

Abstract STUDY QUESTION Does the freeze-all strategy in high-responders increase pregnancy rates and improve safety outcomes when compared with GnRH agonist triggering followed by low-dose hCG intensified luteal support with a fresh embryo transfer? SUMMARY ANSWER Pregnancy rates after either fresh embryo transfer with intensified luteal phase support using low-dose hCG or the freeze-all strategy did not vary significantly; however, moderate-to-severe ovarian hyperstimulation syndrome (OHSS) occurred more frequently in the women who attempted a fresh embryo transfer. WHAT IS KNOWN ALREADY Two strategies following GnRH agonist triggering (the freeze-all approach and a fresh embryo transfer attempt using a low-dose of hCG for intensified luteal phase support) are safer alternatives when compared with conventional hCG triggering with similar pregnancy outcomes. However, these two strategies have never been compared head-to-head in an unrestricted predicted hyper-responder population. STUDY DESIGN, SIZE, DURATION This study included women with an excessive response to ovarian stimulation (≥18 follicles measuring ≥11 mm) undergoing IVF/ICSI in a GnRH antagonist suppressed cycle between 2014 and 2017. Our primary outcome was clinical pregnancy at 7 weeks after the first embryo transfer. Secondary outcomes included live birth and the development of moderate-to-severe OHSS. PARTICIPANTS/MATERIALS, SETTING, METHODS Following GnRH agonist triggering, women were randomized either to cryopreserve all good-quality embryos followed by a frozen embryo transfer in an subsequent artificial cycle or to perform a fresh embryo transfer with intensified luteal phase support (1500 IU hCG on the day of oocyte retrieval, plus oral estradiol 2 mg two times a day, plus 200 mg of micronized vaginal progesterone three times a day). MAIN RESULTS AND THE ROLE OF CHANCE A total of 212 patients (106 in each arm) were recruited in the study, with three patients (one in the fresh embryo transfer group and two in the freeze-all group) later withdrawing their consent to participate in the study. One patient in the freeze-all group became pregnant naturally (clinical pregnancy diagnosed 38 days after randomization) prior to the first frozen embryo transfer. The study arms did not vary significantly in terms of the number of oocytes retrieved and embryos produced/transferred. The intention to treat clinical pregnancy and live birth rates (with the latter excluding four cases lost to follow-up: one in the fresh transfer and three in the freeze-all arms, respectively) after the first embryo transfer did not vary significantly among the fresh embryo transfer and freeze-all study arms: 51/105 (48.6%) versus 57/104 (54.8%) and 41/104 (39.4%) versus 42/101 (41.6%), respectively (relative risk for clinical pregnancy 1.13, 95% CI 0.87–1.47; P = 0.41). However, moderate-to-severe OHSS occurred solely in the group that received low-dose hCG (9/105, 8.6%, 95% CI 3.2% to 13.9% vs 0/104, 95% CI 0 to 3.7, P < 0.01). LIMITATIONS, REASONS FOR CAUTION The sample size calculation was based on a 19% absolute difference in terms of clinical pregnancy rates, therefore smaller differences, as observed in the trial, cannot be reliably excluded as non-significant. WIDER IMPLICATIONS OF THE FINDINGS This study offers the first comparative analysis of two common strategies applied to women performing IVF/ICSI with a high risk to develop OHSS. While pregnancy rates did not vary significantly, a fresh embryo transfer with intensified luteal phase support may still not avoid the risk of moderate-to-severe OHSS and serious consideration should be made before recommending it as a routine first-line treatment. Future trials may allow us to confirm these findings. STUDY FUNDING/COMPETING INTEREST(S) The authors have no conflicts of interest to disclose. No external funding was obtained for this study. TRIAL REGISTRATION NUMBER ClinicalTrials.gov identifier NCT02148393. TRIAL REGISTRATION DATE 28 May 2014 DATE OF FIRST PATIENT’S ENROLMENT 30 May 2014

scholarly journals The impact of mild renal dysfunction on isolated cardiopulmonary coronary artery bypass grafting: a retrospective propensity score matching analysis

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Xian Wang ◽  
Yifan Zhu ◽  
Wen Chen ◽  
Liangpeng Li ◽  
Xin Chen ◽  
...  
Keyword(s):  
Propensity Score ◽  
Propensity Score Matching ◽  
Artery Bypass ◽  
Term Survival ◽  
Group A ◽  
Group B ◽  
The Impact ◽  
New Onset

Abstract Background Mild preoperative renal dysfunction (RD) is not rare in patients receiving isolated cardiopulmonary coronary artery bypass grafting (CCABG). However, there are not too many studies about the impact of mild preoperative RD on in-hospital and follow-up outcomes after isolated CCABG. This single-centre, retrospective propensity score matching study designed to study the impact of mild preoperative RD on in-hospital and long-term outcomes after first isolated CCABG. Methods After propensity score matching, 1144 patients with preoperative estimated glomerular filtration rate (eGFR) of more than 60 ml/min/1.73 m2 receiving first isolated CCABG surgery from January 2012 to December 2015 entered the study, who were divided into 2 groups: A group (eGFR ≥90 ml/min/1.73 m2, n = 572) and B group (eGFR of 60–89 ml/min/1.73 m2, n = 572). The in-hospital and long-term outcomes were recorded and analyzed. The mean follow-up time was 54.4 ± 10.7 months. Acute kidney injury (AKI) was defined and classified according to the Acute Kidney Injury Network (AKIN) criteria. Results The 2 propensity score-matched groups had similar baseline and procedure except the baseline eGFR. There were 8 patients died in A group (mortality is 1.4%) and 14 died in B group (mortality is 2.5%) during the in hospital and 30-day postoperatively(χ2 = 1.159, p = 0.282). There were totally 38 patients lost to follow-up, 18 in group A and 20 in group B. 21 patients died in group A and 37 died in group B during the follow-up, and long-term survival in group A was higher than in group B (96.2% vs 93.1%, χ2 = 4.336, p = 0.037). Comparing with group A, group B was associated with an increased rates and severity of AKI postoperatively (total AKI: 62 vs 144. AKIN stageI: 54 vs 113; AKIN stageII: 6 vs 22; AKIN stageIII: 2 vs 9, p<0.0001). During follow-up, group B also had a higher rate of new onset of dialysis (0 vs 6, χ2 = 4.432, p = 0.039). Multivariable logistic regression showed that comparing with A group, the HR for long-term mortality and new onset of dialysis in B group was 1.67 and 1.52 respectively (95%CI 1.09–2.90, p = 0.035; 95%CI 1.14–2.49, p = 0.027). Conclusions Comparing with normal preoperative renal function, patients with mild preoperative RD had a similar in-hosptial mortality, but with an increased in-hosptial rates and severity of AKI, and with a decreased long-term survival and increased long-term new onset of dialysis.

Propensity Score Matching Analysis Comparing Reduced Intensity Versus Myeloablative Conditioning in AML/MDS Patients Transplanted with Fludarabine-Busulfan-Low Dose Total Body Irradiation Based Regimen

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 3870-3870
Author(s):  
Hassan Sibai ◽  
Fotios V. Michelis ◽  
Nada Hamad ◽  
Jieun Uhm ◽  
Vikas Gupta ◽  
...  
Keyword(s):  
Propensity Score ◽  
Propensity Score Matching ◽  
Low Dose ◽  
Risk Group ◽  
Case Control ◽  
Period Effect ◽  
Myeloablative Conditioning ◽  
Propensity Score Matching Analysis ◽  
Donor Type ◽  
Total Body

Abstract Background: Allogeneic hematopoietic cell transplantation (HCT) is an effective therapy in Acute Myeloid Leukemia and Myelodysplastic Syndrome (AML/MDS). There is controversy over whether reduced intensity conditioning (RIC) results in similar outcomes to myeloablative conditioning (MAC), especially regarding relapse risk. It is difficult to identify the specific cause of the transplant failure rate in RIC patients amongst the multiple possible factors including relapse risk due to disease characteristics of older pts with AML/MDS, or multiple comorbidities in the population receiving RIC, resulting in higher morbidity and mortality, versus expected lower risk of regimen-related toxicity. In order to overcome this, we used a propensity score matching analysis in this study. Methods: A total of 248 patients transplanted for AML or MDS at the Princess Margret Cancer Center between 2009 and 2013 were included in this analysis. Inclusion was restricted to patients receiving Fludarabine/Busulfan plus low dose total body irradiation (TBI) with either RIC conditioning (Fludarabine 30mg/m2/day for 4 days, Busulfan 3.2mg/kg/day for 2 days and TBI 200 cGy n=121) or MAC conditioning (Fludarabine 50mg/m2/day for 4 days, Busulfan 3.2mg/kg/day for 4 days and TBI 400 cGy; n=127). The RIC and MAC groups were compared for overall survival (OS), non-relapse mortality (NRM) and relapse. Propensity score matching (PSM) analysis is used to adjust for the risk factors which affect the choice of treatment between different treatment options. Using PSM analysis, we performed a case-control study with well-balanced pairs of RIC and MAC patients. Pre-transplant variables included in the PSM were age at HCT, HCT-Comorbidity Index (HCT-CI), complete remission status (CR) at HCT, diagnosis (AML vs MDS), cytogenetic risk group (high-risk vs others), donor type (related vs unrelated) and period effect (transplant year). A total of 39 case-control pairs were selected within 0.2 of a difference in propensity score. Paired analysis was adopted throughout the PSM analysis for survival. RESULTS: With a median follow-up of 18 months among survivors in the overall population (n=248), the 2-year OS, NRM and relapse incidence rates were 48.0±3.6%, 34.6±3.6% and 24.8±3.5% respectively There was no difference between the 2 groups in OS (45.2±5.0% in RIC vs 51.7±5.2% in MAC at 2 years; p=0.541) or NRM (32.9±5.2% in RIC vs 35.7±4.9% in MAC at 2 years; p=0.504). However, there was a higher incidence of relapse in the RIC group (31.5±5.1% in RIC vs 18.2±4.8% in MAC at 2 years; p=0.033) Demographic and transplant characteristics were imbalanced between the 2 groups within the overall population, including older age (P=<0.001), higher HCT-CI score (p=0.002) and more related donors in the RIC group (p=0.02). However, no differences were observed in CR status at HCT (p=0.110), subtype of diagnosis (AML vs MDS, p=0.174), or cytogenetic risk group (p=0.278). To overcome baseline imbalances we used a PSM analysis, and 39 case-control pairs (n=78) were selected. All pre-transplant variables became well balanced after propensity score matching, i.e. there were no differences in age (p=0.537), HCT-CI (p=0.931), CR status at HCT (p=0.655), diagnosis (p=0.774), cytogenetic risk group (p=0.784), donor type (p=0.496) or period effect (p=0.984). In the propensity score matched patients, there were no differences in OS (58.0±8.8% in RIC vs 50.9±8.1% in MAC at 2 years; p=0.554), NRM (28.0±8.2% in RIC vs 32.8±7.8% in MAC at 2 years; p=0.688), or relapse (17.8±6.7% in RIC vs 18.0±6.8% in MAC at 2 years; p=0.635). Conclusion: These results suggest, based on a propensity score matching analysis, that the outcomes of a Fludarabine/Busulfan plus low dose TBI based‎ RIC HCT for AML/MDS are equivalent to a Fludarabine/Busulfan plus low dose TBI based MAC with regards to the risk of relapse, NRM, and OS. Disclosures No relevant conflicts of interest to declare.

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