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. 2019 Oct 8;3(19):2836-2844.
doi: 10.1182/bloodadvances.2019000627.

Myeloablative vs reduced intensity T-cell-replete haploidentical transplantation for hematologic malignancy

Scott R Solomon  1 , Andrew St Martin  2 , Nirav N Shah  3 , Giancarlo Fatobene  4 , Monzr M Al Malki  5 , Karen K Ballen  6 , Asad Bashey  1 , Nelli Bejanyan  7 , Javier Bolaños Meade  8 , Claudio G Brunstein  9 , Zachariah DeFilipp  10 , Richard E Champlin  11 , Ephraim J Fuchs  8 , Mehdi Hamadani  2 , Peiman Hematti  12 , Christopher G Kanakry  13 , Joseph P McGuirk  14 , Ian K McNiece  15 , Stefan O Ciurea  11 , Marcelo C Pasquini  2 , Vanderson Rocha  4   16 , Rizwan Romee  17 , Sagar S Patel  18 , Sumithira Vasu  19 , Edmund K Waller  20 , John R Wingard  21 , Mei-Jie Zhang  2 , Mary Eapen  2
Affiliations

Myeloablative vs reduced intensity T-cell-replete haploidentical transplantation for hematologic malignancy

Scott R Solomon et al. Blood Adv. .

Abstract

In the absence of prospective studies that examine the effect of conditioning regimen intensity after T-cell-replete haploidentical transplant for acute myeloid leukemia (AML), acute lymphoblastic leukemia (ALL), and myelodysplastic syndrome (MDS), a retrospective cohort analysis was performed. Of the 1325 eligible patients (AML, n = 818; ALL, n = 286; and MDS, n = 221), 526 patients received a myeloablative regimen and 799 received a reduced-intensity regimen. Graft-versus-host disease prophylaxis was uniform with posttransplant cyclophosphamide, a calcineurin inhibitor, and mycophenolate mofetil. The primary end point was disease-free survival. Cox regression models were built to study the effect of conditioning regimen intensity on transplant outcomes. For patients aged 18 to 54 years, disease-free survival was lower (hazard ratio [HR], 1.34; 42% vs 51%; P = .007) and relapse was higher (HR, 1.51; 44% vs 33%; P = .001) with a reduced-intensity regimen compared with a myeloablative regimen. Nonrelapse mortality did not differ according to regimen intensity. For patients aged 55 to 70 years, disease-free survival (HR, 0.97; 37% vs 43%; P = .83) and relapse (HR, 1.32; 42% vs 31%; P = .11) did not differ according to regimen intensity. Nonrelapse mortality was lower with reduced-intensity regimens (HR, 0.64; 20% vs 31%; P = .02). Myeloablative regimens are preferred for AML, ALL, and MDS; reduced-intensity regimens should be reserved for those unable to tolerate myeloablation.

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Conflict of interest statement

Conflict-of-interest disclosure: The authors declare no competing financial interests.

Figures

None
Graphical abstract
Figure 1.
Figure 1.
Disease-free survival and relapse in patients aged 18 to 54 years. (A) The 3-year adjusted probability of disease-free survival after a myeloablative (MAC) regimen (47%; 95% CI, 41-52) and after a reduced-intensity (RIC) regimen (35%; 95% CI, 29-41) (P = .009). (B) The 3-year adjusted probability of relapse after a MAC regimen (38%; 95% CI, 32-43) and after an RIC regimen (51%; 95% CI, 44-57) (P = .003).
Figure 2.
Figure 2.
Disease-free survival and relapse in patients aged 55 to 70 years. (A) The 3-year adjusted probability of disease-free survival after a myeloablative (MAC) regimen (40%; 95% CI, 32-49) and after a RIC regimen (33%; 95% CI, 28-38) (P = .15). (B) The 3-year adjusted probability of relapse after a MAC regimen (34%; 95% CI, 25-43) and after an RIC regimen (46%; 95% CI, 41-51) (P = .03).
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References

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