Similar outcomes using myeloablative vs reduced-intensity allogeneic transplant preparative regimens for AML or MDS
Although reduced-intensity conditioning (RIC) and non-myeloablative (NMA)-conditioning regimens have been used for over a decade, their relative efficacy vs myeloablative (MA) approaches to allogeneic hematopoietic cell transplantation in patients with AML and myelodysplasia (MDS) is unknown. We com...
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| creator | Luger, S M Ringdén, O Zhang, M-J Pérez, W S Bishop, M R Bornhauser, M Bredeson, C N Cairo, M S Copelan, E A Gale, R P Giralt, S A Gulbas, Z Gupta, V Hale, G A Lazarus, H M Lewis, V A Lill, M C McCarthy, P L Weisdorf, D J Pulsipher, M A |
| description | Although reduced-intensity conditioning (RIC) and non-myeloablative (NMA)-conditioning regimens have been used for over a decade, their relative efficacy vs myeloablative (MA) approaches to allogeneic hematopoietic cell transplantation in patients with AML and myelodysplasia (MDS) is unknown. We compared disease status, donor, graft and recipient characteristics with outcomes of 3731 MA with 1448 RIC/NMA procedures performed at 217 centers between 1997 and 2004. The 5-year univariate probabilities and multivariate relative risk outcomes of relapse, TRM, disease-free survival (DFS) and OS are reported. Adjusted OS at 5 years was 34, 33 and 26% for MA, RIC and NMA transplants, respectively. NMA conditioning resulted in inferior DFS and OS, but there was no difference in DFS and OS between RIC and MA regimens. Late TRM negates early decreases in toxicity with RIC and NMA regimens. Our data suggest that higher regimen intensity may contribute to optimal survival in patients with AML/MDS, suggesting roles for both regimen intensity and graft vs leukemia in these diseases. Prospective studies comparing regimens are needed to confirm this finding and determine the optimal approach to patients who are eligible for either MA or RIC/NMA conditioning. |
| doi_str_mv | 10.1038/bmt.2011.69 |
| format | Article |
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We compared disease status, donor, graft and recipient characteristics with outcomes of 3731 MA with 1448 RIC/NMA procedures performed at 217 centers between 1997 and 2004. The 5-year univariate probabilities and multivariate relative risk outcomes of relapse, TRM, disease-free survival (DFS) and OS are reported. Adjusted OS at 5 years was 34, 33 and 26% for MA, RIC and NMA transplants, respectively. NMA conditioning resulted in inferior DFS and OS, but there was no difference in DFS and OS between RIC and MA regimens. Late TRM negates early decreases in toxicity with RIC and NMA regimens. Our data suggest that higher regimen intensity may contribute to optimal survival in patients with AML/MDS, suggesting roles for both regimen intensity and graft vs leukemia in these diseases. Prospective studies comparing regimens are needed to confirm this finding and determine the optimal approach to patients who are eligible for either MA or RIC/NMA conditioning.</description><identifier>ISSN: 0268-3369</identifier><identifier>EISSN: 1476-5365</identifier><identifier>DOI: 10.1038/bmt.2011.69</identifier><identifier>PMID: 21441963</identifier><identifier>CODEN: BMTRE9</identifier><language>eng</language><publisher>London: Nature Publishing Group UK</publisher><subject>Acute myeloid leukemia ; Adolescent ; Adult ; Aged ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Biological and medical sciences ; Bone marrow ; Bone marrow, stem cells transplantation. Graft versus host reaction ; Cell Biology ; Conditioning ; Disease-Free Survival ; Female ; Graft-versus-host reaction ; Hematologic and hematopoietic diseases ; Hematology ; Hematopoietic Stem Cell Transplantation - methods ; Hematopoietic stem cells ; Humans ; Internal Medicine ; Leukemia ; Leukemia, Myeloid, Acute - surgery ; Leukemia, Myeloid, Acute - therapy ; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis ; Male ; Medical sciences ; Medicine ; Medicine & Public Health ; Middle Aged ; Myelodysplastic syndrome ; Myelodysplastic Syndromes - surgery ; Myelodysplastic Syndromes - therapy ; original-article ; Public Health ; Stem cell transplantation ; Stem Cells ; Survival ; Toxicity ; Transfusions. Complications. Transfusion reactions. Cell and gene therapy ; Transplantation ; Transplantation Conditioning - methods ; Transplantation, Homologous ; Transplants ; Transplants & implants ; Treatment Outcome ; Young Adult</subject><ispartof>Bone marrow transplantation (Basingstoke), 2012-02, Vol.47 (2), p.203-211</ispartof><rights>Macmillan Publishers Limited 2012</rights><rights>2015 INIST-CNRS</rights><rights>COPYRIGHT 2012 Nature Publishing Group</rights><rights>Macmillan Publishers Limited 2012.</rights><rights>Copyright Nature Publishing Group Feb 2012</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c615t-2ec49a2c3db9d7e29d5554920e0edef440d05377620bac6fcd752770d47f83c93</citedby><cites>FETCH-LOGICAL-c615t-2ec49a2c3db9d7e29d5554920e0edef440d05377620bac6fcd752770d47f83c93</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1038/bmt.2011.69$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1038/bmt.2011.69$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>230,314,550,776,780,881,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=25702947$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21441963$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttp://kipublications.ki.se/Default.aspx?queryparsed=id:124112116$$DView record from Swedish Publication Index$$Hfree_for_read</backlink></links><search><creatorcontrib>Luger, S M</creatorcontrib><creatorcontrib>Ringdén, O</creatorcontrib><creatorcontrib>Zhang, M-J</creatorcontrib><creatorcontrib>Pérez, W S</creatorcontrib><creatorcontrib>Bishop, M R</creatorcontrib><creatorcontrib>Bornhauser, M</creatorcontrib><creatorcontrib>Bredeson, C N</creatorcontrib><creatorcontrib>Cairo, M S</creatorcontrib><creatorcontrib>Copelan, E A</creatorcontrib><creatorcontrib>Gale, R P</creatorcontrib><creatorcontrib>Giralt, S A</creatorcontrib><creatorcontrib>Gulbas, Z</creatorcontrib><creatorcontrib>Gupta, V</creatorcontrib><creatorcontrib>Hale, G A</creatorcontrib><creatorcontrib>Lazarus, H M</creatorcontrib><creatorcontrib>Lewis, V A</creatorcontrib><creatorcontrib>Lill, M C</creatorcontrib><creatorcontrib>McCarthy, P L</creatorcontrib><creatorcontrib>Weisdorf, D J</creatorcontrib><creatorcontrib>Pulsipher, M A</creatorcontrib><title>Similar outcomes using myeloablative vs reduced-intensity allogeneic transplant preparative regimens for AML or MDS</title><title>Bone marrow transplantation (Basingstoke)</title><addtitle>Bone Marrow Transplant</addtitle><addtitle>Bone Marrow Transplant</addtitle><description>Although reduced-intensity conditioning (RIC) and non-myeloablative (NMA)-conditioning regimens have been used for over a decade, their relative efficacy vs myeloablative (MA) approaches to allogeneic hematopoietic cell transplantation in patients with AML and myelodysplasia (MDS) is unknown. We compared disease status, donor, graft and recipient characteristics with outcomes of 3731 MA with 1448 RIC/NMA procedures performed at 217 centers between 1997 and 2004. The 5-year univariate probabilities and multivariate relative risk outcomes of relapse, TRM, disease-free survival (DFS) and OS are reported. Adjusted OS at 5 years was 34, 33 and 26% for MA, RIC and NMA transplants, respectively. NMA conditioning resulted in inferior DFS and OS, but there was no difference in DFS and OS between RIC and MA regimens. Late TRM negates early decreases in toxicity with RIC and NMA regimens. Our data suggest that higher regimen intensity may contribute to optimal survival in patients with AML/MDS, suggesting roles for both regimen intensity and graft vs leukemia in these diseases. Prospective studies comparing regimens are needed to confirm this finding and determine the optimal approach to patients who are eligible for either MA or RIC/NMA conditioning.</description><subject>Acute myeloid leukemia</subject><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Biological and medical sciences</subject><subject>Bone marrow</subject><subject>Bone marrow, stem cells transplantation. Graft versus host reaction</subject><subject>Cell Biology</subject><subject>Conditioning</subject><subject>Disease-Free Survival</subject><subject>Female</subject><subject>Graft-versus-host reaction</subject><subject>Hematologic and hematopoietic diseases</subject><subject>Hematology</subject><subject>Hematopoietic Stem Cell Transplantation - methods</subject><subject>Hematopoietic stem cells</subject><subject>Humans</subject><subject>Internal Medicine</subject><subject>Leukemia</subject><subject>Leukemia, Myeloid, Acute - surgery</subject><subject>Leukemia, Myeloid, Acute - therapy</subject><subject>Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Myelodysplastic syndrome</subject><subject>Myelodysplastic Syndromes - surgery</subject><subject>Myelodysplastic Syndromes - therapy</subject><subject>original-article</subject><subject>Public Health</subject><subject>Stem cell transplantation</subject><subject>Stem Cells</subject><subject>Survival</subject><subject>Toxicity</subject><subject>Transfusions. Complications. Transfusion reactions. Cell and gene therapy</subject><subject>Transplantation</subject><subject>Transplantation Conditioning - methods</subject><subject>Transplantation, Homologous</subject><subject>Transplants</subject><subject>Transplants & implants</subject><subject>Treatment Outcome</subject><subject>Young Adult</subject><issn>0268-3369</issn><issn>1476-5365</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><sourceid>D8T</sourceid><recordid>eNqF0s2P1CAUAPDGaNxx9eTdNBr1oB2BFijHya5fyWw8rJ4Jpa-zrLR0ga6Z_35pZtxxzRrLAUJ_D_IeL8ueY7TEqKw_NH1cEoTxkokH2QJXnBW0ZPRhtkCE1UVZMnGUPQnhEiFcVYg-zo5IWmDBykUWzk1vrPK5m6J2PYR8CmbY5P0WrFONVdFcQ34dcg_tpKEtzBBhCCZuc2Wt28AARufRqyGMVg0xHz2Myu_CPGxMn3TeOZ-vztZ5ms5Oz59mjzplAzzbz8fZj08fv598KdbfPn89Wa0LzTCNBQFdCUV02Tai5UBESymtBEGAoIUupdIiWnLOCGqUZp1uOSWco7biXV1qUR5nxe7c8AvGqZGjN73yW-mUkfutn2kFkla0RCj5tzs_enc1QYiyN0GDTXmBm4IUrMasTjX9vySI15TULMmXf8lLN_khpT2jElGBZ_TqX4iwimDOuKgPaqMsSDN0LpVdzxfLFalx-gQnSS3vUWm00BvtBuhM2r8T8OaPgAtQNl4EZ6do3BDuwnc7qL0LwUN3W1CM5NyJMnWinDtRsrn4L_Y5TU0P7a393XoJvN4DFbSyXWohbcLBUY6IqHhy7_evmH4NG_CH4tx37w3RtfK0</recordid><startdate>20120201</startdate><enddate>20120201</enddate><creator>Luger, S M</creator><creator>Ringdén, O</creator><creator>Zhang, M-J</creator><creator>Pérez, W S</creator><creator>Bishop, M R</creator><creator>Bornhauser, M</creator><creator>Bredeson, C N</creator><creator>Cairo, M S</creator><creator>Copelan, E A</creator><creator>Gale, R P</creator><creator>Giralt, S A</creator><creator>Gulbas, Z</creator><creator>Gupta, V</creator><creator>Hale, G A</creator><creator>Lazarus, H M</creator><creator>Lewis, V A</creator><creator>Lill, M C</creator><creator>McCarthy, P L</creator><creator>Weisdorf, D J</creator><creator>Pulsipher, M A</creator><general>Nature Publishing Group UK</general><general>Nature Publishing Group</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7QP</scope><scope>7T5</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>LK8</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>ADTPV</scope><scope>AOWAS</scope><scope>D8T</scope><scope>ZZAVC</scope></search><sort><creationdate>20120201</creationdate><title>Similar outcomes using myeloablative vs reduced-intensity allogeneic transplant preparative regimens for AML or MDS</title><author>Luger, S M ; Ringdén, O ; Zhang, M-J ; Pérez, W S ; Bishop, M R ; Bornhauser, M ; Bredeson, C N ; Cairo, M S ; Copelan, E A ; Gale, R P ; Giralt, S A ; Gulbas, Z ; Gupta, V ; Hale, G A ; Lazarus, H M ; Lewis, V A ; Lill, M C ; McCarthy, P L ; Weisdorf, D J ; Pulsipher, M A</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c615t-2ec49a2c3db9d7e29d5554920e0edef440d05377620bac6fcd752770d47f83c93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Acute myeloid leukemia</topic><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Anesthesia. 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We compared disease status, donor, graft and recipient characteristics with outcomes of 3731 MA with 1448 RIC/NMA procedures performed at 217 centers between 1997 and 2004. The 5-year univariate probabilities and multivariate relative risk outcomes of relapse, TRM, disease-free survival (DFS) and OS are reported. Adjusted OS at 5 years was 34, 33 and 26% for MA, RIC and NMA transplants, respectively. NMA conditioning resulted in inferior DFS and OS, but there was no difference in DFS and OS between RIC and MA regimens. Late TRM negates early decreases in toxicity with RIC and NMA regimens. Our data suggest that higher regimen intensity may contribute to optimal survival in patients with AML/MDS, suggesting roles for both regimen intensity and graft vs leukemia in these diseases. Prospective studies comparing regimens are needed to confirm this finding and determine the optimal approach to patients who are eligible for either MA or RIC/NMA conditioning.</abstract><cop>London</cop><pub>Nature Publishing Group UK</pub><pmid>21441963</pmid><doi>10.1038/bmt.2011.69</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0268-3369 |
| ispartof | Bone marrow transplantation (Basingstoke), 2012-02, Vol.47 (2), p.203-211 |
| issn | 0268-3369 1476-5365 |
| language | eng |
| recordid | cdi_swepub_primary_oai_swepub_ki_se_545300 |
| source | MEDLINE; Springer Nature - Complete Springer Journals; Nature; EZB-FREE-00999 freely available EZB journals; SWEPUB Freely available online |
| subjects | Acute myeloid leukemia Adolescent Adult Aged Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Biological and medical sciences Bone marrow Bone marrow, stem cells transplantation. Graft versus host reaction Cell Biology Conditioning Disease-Free Survival Female Graft-versus-host reaction Hematologic and hematopoietic diseases Hematology Hematopoietic Stem Cell Transplantation - methods Hematopoietic stem cells Humans Internal Medicine Leukemia Leukemia, Myeloid, Acute - surgery Leukemia, Myeloid, Acute - therapy Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis Male Medical sciences Medicine Medicine & Public Health Middle Aged Myelodysplastic syndrome Myelodysplastic Syndromes - surgery Myelodysplastic Syndromes - therapy original-article Public Health Stem cell transplantation Stem Cells Survival Toxicity Transfusions. Complications. Transfusion reactions. Cell and gene therapy Transplantation Transplantation Conditioning - methods Transplantation, Homologous Transplants Transplants & implants Treatment Outcome Young Adult |
| title | Similar outcomes using myeloablative vs reduced-intensity allogeneic transplant preparative regimens for AML or MDS |
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