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Comparative Study
. 2018 Nov 13;2(21):2922-2936.
doi: 10.1182/bloodadvances.2018024844.

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

Saurabh Chhabra  1 , Kwang Woo Ahn  2   3 , Zhen-Huan Hu  3 , Sandeep Jain  4 , Amer Assal  5 , Jan Cerny  6 , Edward A Copelan  7 , Andrew Daly  8 , Zachariah DeFilipp  9 , Shahinaz M Gadalla  10 , Robert Peter Gale  11 , Siddhartha Ganguly  12 , Betty K Hamilton  13 , Gerhard Carl Hildebrandt  14 , Jack W Hsu  15 , Yoshihiro Inamoto  16 , Abraham S Kanate  17 , H Jean Khoury  18 , Hillard M Lazarus  19 , Mark R Litzow  20 , Sunita Nathan  21 , Richard F Olsson  22   23 , Attaphol Pawarode  24 , Olle Ringden  22 , Jacob M Rowe  25 , Ayman Saad  26 , Bipin N Savani  27 , Harry C Schouten  28 , Sachiko Seo  29 , Nirav N Shah  1 , Melhem Solh  30 , Robert K Stuart  4 , Celalettin Ustun  31 , Ann E Woolfrey  32 , Jean A Yared  33 , Edwin P Alyea  34 , Matt E Kalaycio  13 , Uday Popat  35 , Ronald M Sobecks  13 , Wael Saber  3
Affiliations
Comparative Study

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

Saurabh Chhabra et al. Blood Adv. .

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.

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Conflict of interest statement

Conflict-of-interest disclosure: A.A. has advisory board engagements with Boston Biomedical and Incyte Corporation. The remaining authors declare no competing financial interests.

Figures

None
Graphical abstract
Figure 1.
Figure 1.
Outcomes after MAC versus RIC alloHCT for CML. (A) Adjusted curves for NRM after allo-HCT for CML using MAC vs RIC. (B) Adjusted curves for disease relapse after allo-HCT for CML using MAC vs RIC. (C) Adjusted curves for LFS after allo-HCT for CML using MAC vs RIC. (D) Adjusted curves for OS after allo-HCT for CML using MAC vs RIC.
Figure 2.
Figure 2.
Prespecified subgroup analysis according to baseline characteristics showing HRs and 95% CIs for OS after allo-HCT for CML patients using MAC vs RIC, 2007-2014.
See this image and copyright information in PMC

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References

    1. Ohanian M, Kantarjian HM, Quintas-Cardama A, et al. : Tyrosine kinase inhibitors as initial therapy for patients with chronic myeloid leukemia in accelerated phase. Clin Lymphoma Myeloma Leuk. 2014;14:155-162.e1. - PMC - PubMed
    1. Baccarani M, Deininger MW, Rosti G, et al. . European LeukemiaNet recommendations for the management of chronic myeloid leukemia: 2013. Blood. 2013;122(6):872-884. - PMC - PubMed
    1. Saussele S, Lauseker M, Gratwohl A, et al. ; German CML Study Group. Allogeneic hematopoietic stem cell transplantation (allo SCT) for chronic myeloid leukemia in the imatinib era: evaluation of its impact within a subgroup of the randomized German CML Study IV. Blood. 2010;115(10):1880-1885. - PubMed
    1. Giralt SA, Arora M, Goldman JM, et al. ; Chronic Leukemia Working Committee, Center for International Blood and Marrow Transplant Research. Impact of imatinib therapy on the use of allogeneic haematopoietic progenitor cell transplantation for the treatment of chronic myeloid leukaemia. Br J Haematol. 2007;137(5):461-467. - PubMed
    1. Clift RA, Buckner CD, Thomas ED, et al. . Marrow transplantation for patients in accelerated phase of chronic myeloid leukemia. Blood. 1994;84(12):4368-4373. - PubMed

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