Myeloablative Versus Reduced Intensity Conditioning Regimens for Allogeneic Hematopoietic Stem Cell Transplant for Acute
- PDF / 541,146 Bytes
- 7 Pages / 595.276 x 790.866 pts Page_size
- 80 Downloads / 159 Views
ORIGINAL ARTICLE
Myeloablative Versus Reduced Intensity Conditioning Regimens for Allogeneic Hematopoietic Stem Cell Transplant for Acute Myeloid Leukemia and Myelodysplastic Syndrome: A Retrospective Analysis Sanjeev Kumar Sharma1 • Dharma Choudhary1 • Divya Doval1 • Vipin Khandelwal1 • Amee Patel1 • Rasika Setia1 • Tina Dadu1 • Anil Handoo1
Received: 17 July 2020 / Accepted: 13 November 2020 Ó Indian Society of Hematology and Blood Transfusion 2020
Abstract The conditioning regimens used for the alloHSCT include either myeloablative conditioning (MAC) or reduced intensity conditioning (RIC) regimens based on the age, performance status and co-morbidities. Studies comparing the survival outcomes of RIC and MAC alloHSCT in AML and MDS patients have reported contradictory results. We therefore retrospectively analyzed our data of AML and MDS patients who received MAC and RIC allo-HSCT at our center and compared the long term outcome of the two conditioning regimens. One hundred twenty six consecutive patients were evaluated, 32 (25.4%) underwent MAC allo-HSCT and 94 (74.6%) underwent RIC allo-HSCT. The most common MAC regimen used was busulfan plus cyclophosphamide and the most common RIC regimen used was fludarabine plus melphalan. The median age was higher in RIC group (44 years, range 4–75 years) compared to MAC group (31 yrs, range 6–51 yrs, p = 0.001). There was no significant difference in terms of overall survival (p = 0.498), relapse-free survival (p = 0.791) and non-relapse mortality (p = 0.366) between the two groups. In multivariate analysis, only chronic graftversus-host disease resulted in decreased risk of relapse and improved overall survival irrespective of the conditioning regimens used. Keywords Allogeneic stem cell transplant Reduced intensity conditioning Myeloablative conditioning Overall survival GVHD
Introduction Allogeneic hematopoietic stem cell transplantation (alloHSCT) is a potentially curative treatment for acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS). Traditionally, myeloablative conditioning (MAC) has been the standard conditioning regimen for AML patients in need of allo-HSCT. MAC is, however, associated with a high risk of toxicity and nonrelapse mortality (NRM), especially among elderly patients and patients with comorbidities. This led to the exploration of reduced-intensity conditioning (RIC) regimens. Multiple variables have been shown to effect the outcome of allo-HSCT including recipient age, disease status at the time of allo-HSCT, donor type, risk category of AML/MDS patient, co-morbidity status and type of conditioning regimen used [1]. The RIC regimen has extended the approach of allo-HSCT in AML/MDS to include patients who are not eligible for standard allo-HSCT because of their advanced age and/or co-morbidities [2]. Few randomized clinical trials have compared the survival outcomes between MAC and RIC in AML/MDS patients for allo-HSCT [3, 4] and there are still controversies as to which is the best conditioning regimen for a given patient.
Data Loading...
