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Impact of conditioning intensity on outcomes of haploidentical stem cell transplantation for patients with acute myeloid leukemia 45 years of age and over.
Cancer. 2019 05 01; 125(9):1499-1506.C

Abstract

BACKGROUND

T cell-replete haploidentical stem cell transplantation (haplo-SCT) is a valid therapeutic option for adult patients with high-risk acute myeloid leukemia (AML) lacking an HLA-matched sibling or unrelated donor.

METHOD

We retrospectively analyzed the outcomes of 912 AML patients ≥45 years of age who had undergone haplo-SCT with either myeloablative conditioning (MAC; n = 373) or reduced intensity conditioning (RIC; n = 539) regimens.

RESULTS

The median follow-up was 31.1 and 25.7 months for MAC and RIC, respectively. The incidence of relapse and nonrelapse mortality (NRM) were 25.1% versus 28.7% and 31.0% versus 30.3% for MAC and RIC, respectively; 2-year leukemia-free survival (LFS) was 43.9% for MAC versus 41.0% for RIC. In multivariate analysis, the use of MAC versus RIC was not associated with a difference in the outcomes. Results were confirmed in the propensity score-weighted analysis. Disease status and performance status at transplantation were associated with outcomes. Notably, the use of posttransplantation cyclophosphamide was associated with reduced acute graft-versus-host disease (aGVHD) stage III-IV, and NRM and increased overall survival, LFS, and GVHD-free, relapse-free survival. The use of mobilized peripheral blood stem cells was associated with an increased risk of stage II-IV aGVHD.

CONCLUSION

No differences were found between MAC and RIC regimens for haplo-SCT in adults with AML who were ≥45 years of age. The type of GVHD prophylaxis, disease status, and performance status were the major predictors of transplantation outcome. These results may serve as the background for randomized study comparing RIC versus MAC for haplo-SCT in adults with AML.

Authors+Show Affiliations

Section of Hematology, Department of Medicine, University of Perugia, Centro Ricerche Emato-Oncologiche, Perugia, Italy.Department of Hematology and Cell Therapy, Saint-Antoine Hospital, Paris, France. ALWP Office, Saint-Antoine Hospital, Paris, France.Hematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.San Martino Hospital, Department of Haematology II, Genova, Italy.Rome Transplant Network, Tor Vergata, University of Rome, Stem Cell Transplant Unit, Policlinico Universitario Tor Vergata, Rome, Italy.Bone Marrow Transplantation Unit, Cancer Research Center, Institute Paoli Calmettes, Marseille, France.Rome Transplant Network, Tor Vergata, University of Rome, Stem Cell Transplant Unit, Policlinico Universitario Tor Vergata, Rome, Italy.University Hospital of Munich-Grosshadern, LMU, Department of Internal Medicine III, Munich, Germany.S.S.C.V.D Trapianto di Cellule Staminali, A.O.U Citta della Salute e della Scienza di Torino, Presidio Molinette, Torino, Italy.Universitaets Klinikum Dresden, Medizinische Klinik und Poliklinik I, Dresden, Germany.Medical Park Hospitals, Stem Cell Transplant Unit, Antalya, Turkey.Ospedale Civile, Dipartimento di Ematologia, Medicina Trasfusionale e Biotecnologie, Pescara, Italy.Peking University People's Hospital, Institute of Haematology, Beijing, China.ALWP Office, Saint-Antoine Hospital, Paris, France. Vanderbilt University Medical center, Nashville, Tennessee.Department of Hematology and Cell Therapy, Saint-Antoine Hospital, Paris, France. ALWP Office, Saint-Antoine Hospital, Paris, France.Department of Pediatric Hematology and Oncology, IRCCS Bambino Gesù Children's Hospital, Rome, Italy. Cellular Therapy and Immunobiology Working Party of EBMT.ALWP Office, Saint-Antoine Hospital, Paris, France. Department of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel Hashomer, Israel.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30620383

Citation

Santoro, Nicole, et al. "Impact of Conditioning Intensity On Outcomes of Haploidentical Stem Cell Transplantation for Patients With Acute Myeloid Leukemia 45 Years of Age and Over." Cancer, vol. 125, no. 9, 2019, pp. 1499-1506.
Santoro N, Labopin M, Ciceri F, et al. Impact of conditioning intensity on outcomes of haploidentical stem cell transplantation for patients with acute myeloid leukemia 45 years of age and over. Cancer. 2019;125(9):1499-1506.
Santoro, N., Labopin, M., Ciceri, F., Van Lint, M. T., Nasso, D., Blaise, D., Arcese, W., Tischer, J., Bruno, B., Ehninger, G., Koc, Y., Santarone, S., Huang, X. J., Savani, B. N., Mohty, M., Ruggeri, A., & Nagler, A. (2019). Impact of conditioning intensity on outcomes of haploidentical stem cell transplantation for patients with acute myeloid leukemia 45 years of age and over. Cancer, 125(9), 1499-1506. https://doi.org/10.1002/cncr.31941
Santoro N, et al. Impact of Conditioning Intensity On Outcomes of Haploidentical Stem Cell Transplantation for Patients With Acute Myeloid Leukemia 45 Years of Age and Over. Cancer. 2019 05 1;125(9):1499-1506. PubMed PMID: 30620383.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impact of conditioning intensity on outcomes of haploidentical stem cell transplantation for patients with acute myeloid leukemia 45 years of age and over. AU - Santoro,Nicole, AU - Labopin,Myriam, AU - Ciceri,Fabio, AU - Van Lint,Maria Teresa, AU - Nasso,Daniela, AU - Blaise,Didier, AU - Arcese,William, AU - Tischer,Johanna, AU - Bruno,Benedetto, AU - Ehninger,Gerhard, AU - Koc,Yener, AU - Santarone,Stella, AU - Huang,Xiao-Jun, AU - Savani,Bipin N, AU - Mohty,Mohamad, AU - Ruggeri,Annalisa, AU - Nagler,Arnon, Y1 - 2019/01/08/ PY - 2018/08/29/received PY - 2018/11/21/revised PY - 2018/11/27/accepted PY - 2019/1/9/pubmed PY - 2020/1/28/medline PY - 2019/1/9/entrez KW - acute myeloid leukemia KW - haploidentical stem cell transplantation KW - myeloablative conditioning KW - reduced intensity conditioning SP - 1499 EP - 1506 JF - Cancer JO - Cancer VL - 125 IS - 9 N2 - BACKGROUND: T cell-replete haploidentical stem cell transplantation (haplo-SCT) is a valid therapeutic option for adult patients with high-risk acute myeloid leukemia (AML) lacking an HLA-matched sibling or unrelated donor. METHOD: We retrospectively analyzed the outcomes of 912 AML patients ≥45 years of age who had undergone haplo-SCT with either myeloablative conditioning (MAC; n = 373) or reduced intensity conditioning (RIC; n = 539) regimens. RESULTS: The median follow-up was 31.1 and 25.7 months for MAC and RIC, respectively. The incidence of relapse and nonrelapse mortality (NRM) were 25.1% versus 28.7% and 31.0% versus 30.3% for MAC and RIC, respectively; 2-year leukemia-free survival (LFS) was 43.9% for MAC versus 41.0% for RIC. In multivariate analysis, the use of MAC versus RIC was not associated with a difference in the outcomes. Results were confirmed in the propensity score-weighted analysis. Disease status and performance status at transplantation were associated with outcomes. Notably, the use of posttransplantation cyclophosphamide was associated with reduced acute graft-versus-host disease (aGVHD) stage III-IV, and NRM and increased overall survival, LFS, and GVHD-free, relapse-free survival. The use of mobilized peripheral blood stem cells was associated with an increased risk of stage II-IV aGVHD. CONCLUSION: No differences were found between MAC and RIC regimens for haplo-SCT in adults with AML who were ≥45 years of age. The type of GVHD prophylaxis, disease status, and performance status were the major predictors of transplantation outcome. These results may serve as the background for randomized study comparing RIC versus MAC for haplo-SCT in adults with AML. SN - 1097-0142 UR - https://www.unboundmedicine.com/medline/citation/30620383/Impact_of_conditioning_intensity_on_outcomes_of_haploidentical_stem_cell_transplantation_for_patients_with_acute_myeloid_leukemia_45_years_of_age_and_over_ L2 - https://doi.org/10.1002/cncr.31941 DB - PRIME DP - Unbound Medicine ER -