Myeloablative Conditioning for Allogeneic Transplantation Results in Superior Disease-Free Survival for Acute Myelogenous Leukemia and Myelodysplastic Syndromes with Low/Intermediate but not High Disease Risk Index: A Center for International Blood and Marrow Transplant Research Study.

Bejanyan, Nelli; Zhang, Meijie; Bo-Subait, Khalid; Brunstein, Claudio; Wang, Hailin; Warlick, Erica D; Giralt, Sergio; Nishihori, Taiga; Martino, Rodrigo; Passweg, Jakob; Dias, Ajoy; Copelan, Edward; Hale, Gregory; Gale, Robert Peter; Solh, Melhem; Kharfan-Dabaja, Mohamed A; Diaz, Miguel Angel; Ganguly, Siddhartha; Gore, Steven; Verdonck, Leo F; ... (2021). Myeloablative Conditioning for Allogeneic Transplantation Results in Superior Disease-Free Survival for Acute Myelogenous Leukemia and Myelodysplastic Syndromes with Low/Intermediate but not High Disease Risk Index: A Center for International Blood and Marrow Transplant Research Study. Biology of blood and marrow transplantation, 27(1), 68.e1-68.e9. Elsevier 10.1016/j.bbmt.2020.09.026

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Compared with reduced-intensity conditioning (RIC), myeloablative conditioning (MAC) is generally associated with lower relapse risk after allogeneic hematopoietic cell transplantation (HCT) for acute myelogenous leukemia (AML) and myelodysplastic syndromes (MDS). However, disease-specific risk factors in AML/MDS can further inform when MAC and RIC may yield differential outcomes. We analyzed HCT outcomes stratified by the Disease Risk Index (DRI) in 4387 adults (age 40 to 65 years) to identify the impact of conditioning intensity. In the low/intermediate-risk DRI cohort, RIC was associated with lower nonrelapse mortality (NRM) (hazard ratio [HR], .74; 95% confidence interval [CI], .62 to .88; P < .001) but significantly greater relapse risk (HR, 1.54; 95% CI, 1.35 to 1.76; P < .001) and thus inferior disease-free survival (DFS) (HR, 1.19; 95% CI, 1.07 to 1.33; P = .001). In the high/very high-risk DRI cohort, RIC was associated with marginally lower NRM (HR, .83; 95% CI, .68 to 1.00; P = .051) and significantly higher relapse risk (HR, 1.23; 95% CI, 1.08 to 1.41; P = .002), leading to similar DFS using either RIC or MAC. These data support MAC over RIC as the preferred conditioning intensity for patients with AML/MDS with low/intermediate-risk DRI, but with a similar benefit as RIC in high/very high-risk DRI. Novel MAC regimens with less toxicity could benefit all patients, but more potent antineoplastic approaches are needed for the high/very-high risk DRI group.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Clinic of Haematology and Central Haematological Laboratory

UniBE Contributor:

Bacher, Vera Ulrike

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1083-8791

Publisher:

Elsevier

Language:

English

Submitter:

Pierrette Durand Lüthi

Date Deposited:

03 Dec 2020 16:10

Last Modified:

01 Apr 2021 01:31

Publisher DOI:

10.1016/j.bbmt.2020.09.026

PubMed ID:

33010430

Uncontrolled Keywords:

AML DRI MDS Myeloablative RIC

BORIS DOI:

10.7892/boris.147695

URI:

https://boris.unibe.ch/id/eprint/147695

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