TY - JOUR
T1 - 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
T2 - A Center for International Blood and Marrow Transplant Research Study
AU - Bejanyan, Nelli
AU - Zhang, Meijie
AU - Bo-Subait, Khalid
AU - Brunstein, Claudio
AU - Wang, Hailin
AU - Warlick, Erica D.
AU - Giralt, Sergio
AU - Nishihori, Taiga
AU - Martino, Rodrigo
AU - Passweg, Jakob
AU - Dias, Ajoy
AU - Copelan, Edward
AU - Hale, Gregory
AU - Gale, Robert Peter
AU - Solh, Melhem
AU - Kharfan-Dabaja, Mohamed A.
AU - Diaz, Miguel Angel
AU - Ganguly, Siddhartha
AU - Gore, Steven
AU - Verdonck, Leo F.
AU - Hossain, Nasheed M.
AU - Kekre, Natasha
AU - Savani, Bipin
AU - Byrne, Michael
AU - Kanakry, Christopher
AU - Cairo, Mitchell S.
AU - Ciurea, Stefan
AU - Schouten, Harry C.
AU - Bredeson, Christopher
AU - Munker, Reinhold
AU - Lazarus, Hillard
AU - Cahn, Jean Yves
AU - van Der Poel, Marjolein
AU - Rizzieri, David
AU - Yared, Jean A.
AU - Freytes, Cesar
AU - Cerny, Jan
AU - Aljurf, Mahmoud
AU - Palmisiano, Neil D.
AU - Pawarode, Attaphol
AU - Bacher, Vera Ulrike
AU - Grunwald, Michael R.
AU - Nathan, Sunita
AU - Wirk, Baldeep
AU - Hildebrandt, Gerhard C.
AU - Seo, Sachiko
AU - Olsson, Richard F.
AU - George, Biju
AU - de Lima, Marcos
AU - Hourigan, Christopher S.
AU - Sandmaier, Brenda M.
AU - Litzow, Mark
AU - Kebriaei, Partow
AU - Saber, Wael
AU - Weisdorf, Daniel
N1 - Publisher Copyright:
© 2020 American Society for Transplantation and Cellular Therapy
PY - 2020
Y1 - 2020
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85095870377&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85095870377&partnerID=8YFLogxK
U2 - 10.1016/j.bbmt.2020.09.026
DO - 10.1016/j.bbmt.2020.09.026
M3 - Article
C2 - 33010430
AN - SCOPUS:85095870377
SN - 1083-8791
JO - Biology of Blood and Marrow Transplantation
JF - Biology of Blood and Marrow Transplantation
ER -