Myeloablative vs reduced-intensity conditioning allogeneic hematopoietic cell transplantation for chronic myeloid leukemia

S. Chhabra*, K.W. Ahn, Z.H. Hu, S. Jain, A. Assal, J. Cerny, E.A. Copelan, A. Daly, Z. DeFilipp, S.M. Gadalla, R.P. Gale, S. Ganguly, B.K. Hamilton, G.C. Hildebrandt, J.W. Hsu, Y. Inamoto, A.S. Kanate, H.J. Khoury, H.M. Lazarus, M.R. LitzowS. Nathan, R.F. Olsson, A. Pawarode, O. Ringden, J.M. Rowe, A. Saad, B.N. Savani, H.C. Schouten, S. Seo, N.N. Shah, M. Solh, R.K. Stuart, C. Ustun, A.E. Woolfrey, J.A. Yared, E.P. Alyea, M.E. Kalaycio, U. Popat, R.M. Sobecks, W. Saber

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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.
Original languageEnglish
Pages (from-to)2922-2936
Number of pages15
JournalBlood advances
Volume2
Issue number21
DOIs
Publication statusPublished - 13 Nov 2018

Keywords

  • VERSUS-HOST-DISEASE
  • CHRONIC MYELOGENOUS LEUKEMIA
  • UNRELATED DONOR TRANSPLANTATION
  • CHROMOSOME-POSITIVE LEUKEMIA
  • ACUTE LYMPHOBLASTIC-LEUKEMIA
  • MARROW-TRANSPLANTATION
  • CHRONIC GRAFT
  • TYROSINE KINASE
  • WORKING PARTY
  • BONE-MARROW

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