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. 2021 Jan;27(1):68.e1-68.e9.
doi: 10.1016/j.bbmt.2020.09.026. Epub 2020 Oct 1.

Myeloablative Conditioning for Allogeneic Transplantation Results in Superior Disease-Free Survival for Acute Myelogenous Leukemia and Myelodysplastic Syndromes with Low/Intermediate but not High Disease Risk Index: A Center for International Blood and Marrow Transplant Research Study

Nelli Bejanyan  1 , Meijie Zhang  2 , Khalid Bo-Subait  2 , Claudio Brunstein  3 , Hailin Wang  2 , Erica D Warlick  3 , Sergio Giralt  4 , Taiga Nishihori  5 , Rodrigo Martino  6 , Jakob Passweg  7 , Ajoy Dias  8 , Edward Copelan  9 , Gregory Hale  10 , Robert Peter Gale  11 , Melhem Solh  12 , Mohamed A Kharfan-Dabaja  13 , Miguel Angel Diaz  14 , Siddhartha Ganguly  15 , Steven Gore  16 , Leo F Verdonck  17 , Nasheed M Hossain  18 , Natasha Kekre  19 , Bipin Savani  20 , Michael Byrne  20 , Christopher Kanakry  21 , Mitchell S Cairo  22 , Stefan Ciurea  23 , Harry C Schouten  24 , Christopher Bredeson  19 , Reinhold Munker  25 , Hillard Lazarus  26 , Jean-Yves Cahn  27 , Marjolein van Der Poel  28 , David Rizzieri  29 , Jean A Yared  30 , Cesar Freytes  31 , Jan Cerny  32 , Mahmoud Aljurf  33 , Neil D Palmisiano  34 , Attaphol Pawarode  35 , Vera Ulrike Bacher  36 , Michael R Grunwald  9 , Sunita Nathan  37 , Baldeep Wirk  38 , Gerhard C Hildebrandt  25 , Sachiko Seo  39 , Richard F Olsson  40 , Biju George  41 , Marcos de Lima  42 , Christopher S Hourigan  43 , Brenda M Sandmaier  44 , Mark Litzow  45 , Partow Kebriaei  23 , Wael Saber  2 , Daniel Weisdorf  46
Affiliations

Myeloablative Conditioning for Allogeneic Transplantation Results in Superior Disease-Free Survival for Acute Myelogenous Leukemia and Myelodysplastic Syndromes with Low/Intermediate but not High Disease Risk Index: A Center for International Blood and Marrow Transplant Research Study

Nelli Bejanyan et al. Transplant Cell Ther. 2021 Jan.

Abstract

Compared with reduced-intensity conditioning (RIC), myeloablative conditioning (MAC) is generally associated with lower relapse risk after allogeneic hematopoietic cell transplantation (HCT) for acute myelogenous leukemia (AML) and myelodysplastic syndromes (MDS). However, disease-specific risk factors in AML/MDS can further inform when MAC and RIC may yield differential outcomes. We analyzed HCT outcomes stratified by the Disease Risk Index (DRI) in 4387 adults (age 40 to 65 years) to identify the impact of conditioning intensity. In the low/intermediate-risk DRI cohort, RIC was associated with lower nonrelapse mortality (NRM) (hazard ratio [HR], .74; 95% confidence interval [CI], .62 to .88; P < .001) but significantly greater relapse risk (HR, 1.54; 95% CI, 1.35 to 1.76; P < .001) and thus inferior disease-free survival (DFS) (HR, 1.19; 95% CI, 1.07 to 1.33; P = .001). In the high/very high-risk DRI cohort, RIC was associated with marginally lower NRM (HR, .83; 95% CI, .68 to 1.00; P = .051) and significantly higher relapse risk (HR, 1.23; 95% CI, 1.08 to 1.41; P = .002), leading to similar DFS using either RIC or MAC. These data support MAC over RIC as the preferred conditioning intensity for patients with AML/MDS with low/intermediate-risk DRI, but with a similar benefit as RIC in high/very high-risk DRI. Novel MAC regimens with less toxicity could benefit all patients, but more potent antineoplastic approaches are needed for the high/very-high risk DRI group.

Keywords: AML; DRI; MDS; Myeloablative; RIC.

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Figures

Figure 1.
Figure 1.
Adjusted clinical outcomes of AML and MDS HCT by DRI and conditioning intensity
See this image and copyright information in PMC

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