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Myeloablative vs reduced-intensity conditioning allogeneic hematopoietic cell transplantation for chronic myeloid leukemia.


ABSTRACT: Allogeneic hematopoietic cell transplantation (allo-HCT) is a potentially curative treatment of chronic myeloid leukemia (CML). Optimal conditioning intensity for allo-HCT for CML in the era of tyrosine kinase inhibitors (TKIs) is unknown. Using the Center for International Blood and Marrow Transplant Research database, we sought to determine whether reduced-intensity/nonmyeloablative conditioning (RIC) allo-HCT and myeloablative conditioning (MAC) result in similar outcomes in CML patients. We evaluated 1395 CML allo-HCT recipients between the ages of 18 and 60 years. The disease status at transplant was divided into the following categories: chronic phase 1, chronic phase 2 or greater, and accelerated phase. Patients in blast phase at transplant and alternative donor transplants were excluded. The primary outcome was overall survival (OS) after allo-HCT. MAC (n = 1204) and RIC allo-HCT recipients (n = 191) from 2007 to 2014 were included. Patient, disease, and transplantation characteristics were similar, with a few exceptions. Multivariable analysis showed no significant difference in OS between MAC and RIC groups. In addition, leukemia-free survival and nonrelapse mortality did not differ significantly between the 2 groups. Compared with MAC, the RIC group had a higher risk of early relapse after allo-HCT (hazard ratio [HR], 1.85; P = .001). The cumulative incidence of chronic graft-versus-host disease (cGVHD) was lower with RIC than with MAC (HR, 0.77; P = .02). RIC provides similar survival and lower cGVHD compared with MAC and therefore may be a reasonable alternative to MAC for CML patients in the TKI era.

SUBMITTER: Chhabra S 

PROVIDER: S-EPMC6234373 | biostudies-literature | 2018 Nov

REPOSITORIES: biostudies-literature

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Myeloablative vs reduced-intensity conditioning allogeneic hematopoietic cell transplantation for chronic myeloid leukemia.

Chhabra Saurabh S   Ahn Kwang Woo KW   Hu Zhen-Huan ZH   Jain Sandeep S   Assal Amer A   Cerny Jan J   Copelan Edward A EA   Daly Andrew A   DeFilipp Zachariah Z   Gadalla Shahinaz M SM   Gale Robert Peter RP   Ganguly Siddhartha S   Hamilton Betty K BK   Hildebrandt Gerhard Carl GC   Hsu Jack W JW   Inamoto Yoshihiro Y   Kanate Abraham S AS   Khoury H Jean HJ   Lazarus Hillard M HM   Litzow Mark R MR   Nathan Sunita S   Olsson Richard F RF   Pawarode Attaphol A   Ringden Olle O   Rowe Jacob M JM   Saad Ayman A   Savani Bipin N BN   Schouten Harry C HC   Seo Sachiko S   Shah Nirav N NN   Solh Melhem M   Stuart Robert K RK   Ustun Celalettin C   Woolfrey Ann E AE   Yared Jean A JA   Alyea Edwin P EP   Kalaycio Matt E ME   Popat Uday U   Sobecks Ronald M RM   Saber Wael W  

Blood advances 20181101 21


Allogeneic hematopoietic cell transplantation (allo-HCT) is a potentially curative treatment of chronic myeloid leukemia (CML). Optimal conditioning intensity for allo-HCT for CML in the era of tyrosine kinase inhibitors (TKIs) is unknown. Using the Center for International Blood and Marrow Transplant Research database, we sought to determine whether reduced-intensity/nonmyeloablative conditioning (RIC) allo-HCT and myeloablative conditioning (MAC) result in similar outcomes in CML patients. We  ...[more]

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