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Comparative outcome of reduced intensity and myeloablative conditioning regimen in HLA identical sibling allogeneic hematopoietic stem cell transplantation for acute leukemia patients: a single center experience.
Transfus Apher Sci. 2013 Dec; 49(3):590-9.TA

Abstract

Due to the high transplant related morbidity and mortality (TRM), relatively younger acute leukemia patients that have a good performance status and no comorbidity are eligible for myeloablative conditioning (MAC) followed by allogeneic hematopoietic stem cell transplantation (allo-HSCT). The outcomes of 84 consecutive adult patients with ALL (n=38) or AML (n=46) who underwent allo-HSCT from their HLA-identical siblings were evaluated retrospectively. The median age at transplantation was 34 (17-58 years) for the whole patient population. Of these, 24 patients received a MAC and 60 patients received a fludarabine-based reduced intensity conditioning regimen (RIC). After a median follow-up of 32 months (range, 1-119), for the entire group, the 3-year estimated overall survival (OS) was 57.5% and the disease-free survival (DFS) was 51.5%. The OS for ALL and AML patients were 53.9% vs 62.1%: and DFS were 50.5% and 53.4%, respectively. The 3-year estimated OS for RIC and MAC patients were 63.2% and 41.7%; and DFS were 57.1% and 34.7%, respectively. In ALL patients, conditioning regimens (RIC vs MAC) led to similar OS and DFS; however, in AML patients both OS (70.1% vs 21.4%) and DFS (59.3% vs 42.9%) were found to be higher in RIC patients compared to MAC recipients. Overall, the TRM at day 100 was 1.7% and has increased up to 5.1% at 1st year. In multivariate analysis, the diagnosis (p=0.03) and RIC regimen (p=0.027) were the prognostic variables for prolonged OS in all patients; and RIC regimen (p=0.031) was the only prognostic factor for prolonged OS in AML patients. The first complete remission (CR1) was correlated with a prolonged DFS as an independent variable for all patients (p=0.09). Eleven of the RIC patients (18.3%) and 6 of the MAC patients (25%) developed acute graft-versus-host disease (GvHD). Seventeen of the RIC patients (33.3%) and 4 of the MAC patients (16.7%) developed chronic GvHD. In conclusion, RIC conditioning regimens may provide a longer OS and DFS, especially in patients with AML who are in first CR, not eligible for MAC conditioning.

Authors+Show Affiliations

Division of Hematology, Department of Internal Medicine, Hacettepe University Medical School, Ankara, Turkey.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

23981652

Citation

Goker, Hakan, et al. "Comparative Outcome of Reduced Intensity and Myeloablative Conditioning Regimen in HLA Identical Sibling Allogeneic Hematopoietic Stem Cell Transplantation for Acute Leukemia Patients: a Single Center Experience." Transfusion and Apheresis Science : Official Journal of the World Apheresis Association : Official Journal of the European Society for Haemapheresis, vol. 49, no. 3, 2013, pp. 590-9.
Goker H, Ozdemir E, Uz B, et al. Comparative outcome of reduced intensity and myeloablative conditioning regimen in HLA identical sibling allogeneic hematopoietic stem cell transplantation for acute leukemia patients: a single center experience. Transfus Apher Sci. 2013;49(3):590-9.
Goker, H., Ozdemir, E., Uz, B., Buyukasik, Y., Turgut, M., Serefhanoglu, S., Aksu, S., Sayinalp, N., Haznedaroglu, I. C., Tekin, F., Karacan, Y., Unal, S., Eliacik, E., Isik, A., & Ozcebe, O. I. (2013). Comparative outcome of reduced intensity and myeloablative conditioning regimen in HLA identical sibling allogeneic hematopoietic stem cell transplantation for acute leukemia patients: a single center experience. Transfusion and Apheresis Science : Official Journal of the World Apheresis Association : Official Journal of the European Society for Haemapheresis, 49(3), 590-9. https://doi.org/10.1016/j.transci.2013.07.030
Goker H, et al. Comparative Outcome of Reduced Intensity and Myeloablative Conditioning Regimen in HLA Identical Sibling Allogeneic Hematopoietic Stem Cell Transplantation for Acute Leukemia Patients: a Single Center Experience. Transfus Apher Sci. 2013;49(3):590-9. PubMed PMID: 23981652.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparative outcome of reduced intensity and myeloablative conditioning regimen in HLA identical sibling allogeneic hematopoietic stem cell transplantation for acute leukemia patients: a single center experience. AU - Goker,Hakan, AU - Ozdemir,Evren, AU - Uz,Burak, AU - Buyukasik,Yahya, AU - Turgut,Mehmet, AU - Serefhanoglu,Songul, AU - Aksu,Salih, AU - Sayinalp,Nilgun, AU - Haznedaroglu,Ibrahim C, AU - Tekin,Fatma, AU - Karacan,Yasemin, AU - Unal,Sevilay, AU - Eliacik,Eylem, AU - Isik,Ayse, AU - Ozcebe,Osman I, Y1 - 2013/08/08/ PY - 2013/04/03/received PY - 2013/07/29/accepted PY - 2013/8/29/entrez PY - 2013/8/29/pubmed PY - 2014/9/24/medline KW - Allogeneic hematopoietic stem cell transplantation KW - Graft-versus-host disease KW - Myeloablative conditioning regimen KW - Reduced intensity conditioning regimen SP - 590 EP - 9 JF - Transfusion and apheresis science : official journal of the World Apheresis Association : official journal of the European Society for Haemapheresis JO - Transfus Apher Sci VL - 49 IS - 3 N2 - Due to the high transplant related morbidity and mortality (TRM), relatively younger acute leukemia patients that have a good performance status and no comorbidity are eligible for myeloablative conditioning (MAC) followed by allogeneic hematopoietic stem cell transplantation (allo-HSCT). The outcomes of 84 consecutive adult patients with ALL (n=38) or AML (n=46) who underwent allo-HSCT from their HLA-identical siblings were evaluated retrospectively. The median age at transplantation was 34 (17-58 years) for the whole patient population. Of these, 24 patients received a MAC and 60 patients received a fludarabine-based reduced intensity conditioning regimen (RIC). After a median follow-up of 32 months (range, 1-119), for the entire group, the 3-year estimated overall survival (OS) was 57.5% and the disease-free survival (DFS) was 51.5%. The OS for ALL and AML patients were 53.9% vs 62.1%: and DFS were 50.5% and 53.4%, respectively. The 3-year estimated OS for RIC and MAC patients were 63.2% and 41.7%; and DFS were 57.1% and 34.7%, respectively. In ALL patients, conditioning regimens (RIC vs MAC) led to similar OS and DFS; however, in AML patients both OS (70.1% vs 21.4%) and DFS (59.3% vs 42.9%) were found to be higher in RIC patients compared to MAC recipients. Overall, the TRM at day 100 was 1.7% and has increased up to 5.1% at 1st year. In multivariate analysis, the diagnosis (p=0.03) and RIC regimen (p=0.027) were the prognostic variables for prolonged OS in all patients; and RIC regimen (p=0.031) was the only prognostic factor for prolonged OS in AML patients. The first complete remission (CR1) was correlated with a prolonged DFS as an independent variable for all patients (p=0.09). Eleven of the RIC patients (18.3%) and 6 of the MAC patients (25%) developed acute graft-versus-host disease (GvHD). Seventeen of the RIC patients (33.3%) and 4 of the MAC patients (16.7%) developed chronic GvHD. In conclusion, RIC conditioning regimens may provide a longer OS and DFS, especially in patients with AML who are in first CR, not eligible for MAC conditioning. SN - 1473-0502 UR - https://www.unboundmedicine.com/medline/citation/23981652/Comparative_outcome_of_reduced_intensity_and_myeloablative_conditioning_regimen_in_HLA_identical_sibling_allogeneic_hematopoietic_stem_cell_transplantation_for_acute_leukemia_patients:_a_single_center_experience_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1473-0502(13)00257-7 DB - PRIME DP - Unbound Medicine ER -