Myeloablative (MAC) as compared to reduced-intensity conditioning (RIC) is generally associated with lower relapse risk after allogeneic hematopoietic cell transplantation (HCT) for acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS). However, disease specific risk factors in AML/MDS can further inform when MAC vs. RIC may yield differential outcomes. We analyzed HCT outcomes stratified by the disease risk index (DRI) in 4387 adults (age 40-65 years) to identify the impact of conditioning intensity. In the low/intermediate risk DRI cohort, RIC was associated with lower non-relapse mortality (NRM) (HR=0.74, 95% CI 0.62-0.88; p<0.001), but significantly higher relapse risk (HR=1.54, 95% CI 1.35-1.76; p<0.001) and thus inferior disease-free survival (DFS) (HR=1.19, 95% CI 1.07-1.33; p=0.001). In the high/very high risk DRI cohort, RIC resulted in marginally lower NRM (HR=0.83, 95% CI 0.68-1.00; p=0.051), and significantly higher relapse risk (HR=1.23, 95% CI 1.08-1.41; p=0.002) leading to similar DFS using either RIC or MAC. These data support MAC over RIC as the preferred conditioning intensity for AML/MDS with low/intermediate risk DRI, but similar benefit to RIC in high/very high risk DRI. Novel MAC regimens with less toxicity could benefit all, but more potent anti-neoplastic approaches are needed for the high/very high risk DRI group.Copyright © 2020. Published by Elsevier Inc.
About The Expert
Nelli Bejanyan
Meijie Zhang
Khalid Bo-Subait
Claudio Brunstein
Hailin Wang
Erica D Warlick
Sergio Giralt
Taiga Nishihori
Rodrigo Martino
Jakob Passweg
Ajoy Dias
Edward Copelan
Gregory Hale
Robert Peter Gale
Melhem Solh
Mohamed A Kharfan-Dabaja
Miguel Angel Diaz
Siddhartha Ganguly
Steven Gore
Leo F Verdonck
Nasheed M Hossain
Natasha Kekre
Bipin Savani
Michael Byrne
Christopher Kanakry
Mitchell S Cairo
Stefan Ciurea
Harry C Schouten
Christopher Bredeson
Reinhold Munker
Hillard Lazarus
Jean-Yves Cahn
Marjolein van Der Poel
David Rizzieri
Jean A Yared
Cesar Freytes
Jan Cerny
Mahmoud Aljurf
Neil D Palmisiano
Attaphol Pawarode
Vera Ulrike Bacher
Michael R Grunwald
Sunita Nathan
Baldeep Wirk
Gerhard C Hildebrandt
Sachiko Seo
Richard F Olsson
Biju George
Marcos de Lima
Christopher S Hourigan
Brenda Sandmaier
Mark Litzow
Partow Kebriaei
Wael Saber
Daniel Weisdorf
References
PubMed