Faculty Collaboration Database

Myeloablative vs reduced-intensity conditioning allogeneic hematopoietic cell transplantation for chronic myeloid leukemia. Blood Adv 2018 Nov 13;2(21):2922-2936

Date

11/07/2018

Pubmed ID

30396912

Pubmed Central ID

PMC6234373

DOI

10.1182/bloodadvances.2018024844

Scopus ID

2-s2.0-85064089410 (requires institutional sign-in at Scopus site)   27 Citations

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.

Author List

Chhabra S, Ahn KW, Hu ZH, Jain S, Assal A, Cerny J, Copelan EA, Daly A, DeFilipp Z, Gadalla SM, Gale RP, Ganguly S, Hamilton BK, Hildebrandt GC, Hsu JW, Inamoto Y, Kanate AS, Khoury HJ, Lazarus HM, Litzow MR, Nathan S, Olsson RF, Pawarode A, Ringden O, Rowe JM, Saad A, Savani BN, Schouten HC, Seo S, Shah NN, Solh M, Stuart RK, Ustun C, Woolfrey AE, Yared JA, Alyea EP, Kalaycio ME, Popat U, Sobecks RM, Saber W

Authors

Kwang Woo Ahn PhD Professor in the Institute for Health and Equity department at Medical College of Wisconsin
Wael Saber MD, MS Professor in the Medicine department at Medical College of Wisconsin
Nirav N. Shah MD Associate Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Adult
Alemtuzumab
Female
Graft vs Host Disease
Hematopoietic Stem Cell Transplantation
Humans
Leukemia, Myelogenous, Chronic, BCR-ABL Positive
Male
Middle Aged
Multivariate Analysis
Proportional Hazards Models
Prospective Studies
Recurrence
Survival Rate
Transplantation Conditioning
Transplantation, Homologous
Young Adult