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Myeloablative Versus Reduced Intensity Conditioning Regimens for Allogeneic Hematopoietic Stem Cell Transplant for Acute Myeloid Leukemia and Myelodysplastic Syndrome: A Retrospective Analysis

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Indian Journal of Hematology and Blood Transfusion Aims and scope Submit manuscript

Abstract

The conditioning regimens used for the allo-HSCT include either myeloablative conditioning (MAC) or reduced intensity conditioning (RIC) regimens based on the age, performance status and co-morbidities. Studies comparing the survival outcomes of RIC and MAC allo-HSCT in AML and MDS patients have reported contradictory results. We therefore retrospectively analyzed our data of AML and MDS patients who received MAC and RIC allo-HSCT at our center and compared the long term outcome of the two conditioning regimens. One hundred twenty six consecutive patients were evaluated, 32 (25.4%) underwent MAC allo-HSCT and 94 (74.6%) underwent RIC allo-HSCT. The most common MAC regimen used was busulfan plus cyclophosphamide and the most common RIC regimen used was fludarabine plus melphalan. The median age was higher in RIC group (44 years, range 4–75 years) compared to MAC group (31 yrs, range 6–51 yrs, p = 0.001). There was no significant difference in terms of overall survival (p = 0.498), relapse-free survival (p = 0.791) and non-relapse mortality (p = 0.366) between the two groups. In multivariate analysis, only chronic graft-versus-host disease resulted in decreased risk of relapse and improved overall survival irrespective of the conditioning regimens used.

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References

  1. Wahid SFA (2013) Indications and outcomes of reduced-toxicity hematopoietic stem cell transplantation in adult patients with hematological malignancies. Int J Hematol 97(5):581–598

    Article  Google Scholar 

  2. Horwitz ME (2011) Reduced intensity versus myeloablative allogeneic stem cell transplantation for the treatment of acute myeloid leukemia, myelodysplastic syndrome and acute lymphoid leukemia. Curr Opin Oncol 23(2):197–202

    Article  Google Scholar 

  3. Bornhäuser M, Kienast J, Trenschel R, Burchert A, Hegenbart U, Stadler M et al (2012) Reduced-intensity conditioning versus standard conditioning before allogeneic haemopoietic cell transplantation in patients with acute myeloid leukaemia in first complete remission: a prospective, open-label randomised phase 3 trial. Lancet Oncol 13(10):1035–1044

    Article  Google Scholar 

  4. Scott BL, Pasquini MC, Logan BR, Wu J, Devine SM, Porter DL et al (2017) Myeloablative versus reduced-intensity hematopoietic cell transplantation for acute myeloid leukemia and myelodysplastic syndromes. J Clin Oncol 35(11):1154–1161

    Article  Google Scholar 

  5. Bacigalupo A, Ballen K, Rizzo D, Giralt S, Lazarus H, Ho V et al (2009) Defining the intensity of conditioning regimens: working definitions. Biol Blood Marrow Transpl 15(12):1628–1633

    Article  Google Scholar 

  6. Filipovich AH, Weisdorf D, Pavletic S, Socie G, Wingard JR, Lee SJ et al (2005) National Institutes of Health consensus development project on criteria for clinical trials in chronic graft-versus-host disease: I. diagnosis and staging working group report. Biol Blood Marrow Transpl 11(12):945–956

    Article  Google Scholar 

  7. Aoudjhane M, Labopin M, Gorin NC, Shimoni A, Ruutu T, Kolb H-J et al (2005) Comparative outcome of reduced intensity and myeloablative conditioning regimen in HLA identical sibling allogeneic haematopoietic stem cell transplantation for patients older than 50 years of age with acute myeloblastic leukaemia: a retrospective survey from the Acute Leukemia Working Party (ALWP) of the European group for Blood and Marrow Transplantation (EBMT). Leukemia 19(12):2304–2312

    Article  CAS  Google Scholar 

  8. Luger SM, Ringdén O, Zhang M-J, Pérez WS, Bishop MR, Bornhauser M et al (2012) Similar outcomes using myeloablative vs reduced-intensity allogeneic transplant preparative regimens for AML or MDS. Bone Marrow Transpl 47(2):203–211

    Article  CAS  Google Scholar 

  9. Goker H, Ozdemir E, Uz B, Buyukasik Y, Turgut M, Serefhanoglu S et al (2013) Comparative outcome of reduced intensity and myeloablative conditioning regimen in HLA identical sibling allogeneic hematopoietic stem cell transplantation for acute leukemia patients: a single center experience. Transfus Apher Sci 49(3):590–599

    Article  Google Scholar 

  10. Valcárcel D, Martino R, Caballero D, Martin J, Ferra C, Nieto JB et al (2008) Sustained remissions of high-risk acute myeloid leukemia and myelodysplastic syndrome after reduced-intensity conditioning allogeneic hematopoietic transplantation: chronic graft-versus-host disease is the strongest factor improving survival. J Clin Oncol 26(4):577–584

    Article  Google Scholar 

  11. Ganapule A, Nemani S, Korula A, Lakshmi KM, Abraham A et al (2017) Allogeneic stem cell transplant for acute myeloid leukemia: evolution of an effective strategy in India. J Glob Oncol 3(6):773–781

    Article  Google Scholar 

  12. Abdul Wahid SF, Ismail N-A, Mohd-Idris M-R, Jamaluddin FW, Tumian N, Sze-Wei EY et al (2014) Comparison of reduced-intensity and myeloablative conditioning regimens for allogeneic hematopoietic stem cell transplantation in patients with acute myeloid leukemia and acute lymphoblastic leukemia: a meta-analysis. Stem Cells Dev 23(21):2535–2552

    Article  Google Scholar 

  13. Kröger N, Iacobelli S, Franke G-N, Platzbecker U, Uddin R, Hübel K et al (2017) Dose- reduced versus standard conditioning followed by allogeneic stem-cell transplantation for patients with myelodysplastic syndrome: a prospective randomized phase III study of the EBMT (RICMAC Trial). J Clin Oncol 35(19):2157–2164

    Article  Google Scholar 

  14. Sharma SK, Choudhary D, Kaul E, Kharya G, Khandelwal V, Kothari S et al (2016) Hematopoietic stem cell transplant in elderly patients: Experience from a tertiary care centre in Northern India. Indian J Hematol Blood Transfus 32:205–207

    Article  Google Scholar 

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Acknowledgements

We are thankful to Ms Saheli and Ms Anubha for collecting and formatting the data.

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Authors and Affiliations

  1. Department of Hemato-Oncology and Bone Marrow Transplantation, BLK Superspeciality Hospital, New Delhi, 110005, India

    Sanjeev Kumar Sharma, Dharma Choudhary, Divya Doval, Vipin Khandelwal, Amee Patel, Rasika Setia, Tina Dadu & Anil Handoo

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  1. Sanjeev Kumar Sharma
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  2. Dharma Choudhary
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  3. Divya Doval
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  4. Vipin Khandelwal
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  7. Tina Dadu
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Correspondence to Sanjeev Kumar Sharma.

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Sharma, S.K., Choudhary, D., Doval, D. et al. Myeloablative Versus Reduced Intensity Conditioning Regimens for Allogeneic Hematopoietic Stem Cell Transplant for Acute Myeloid Leukemia and Myelodysplastic Syndrome: A Retrospective Analysis. Indian J Hematol Blood Transfus 37, 472–478 (2021). https://doi.org/10.1007/s12288-020-01386-6

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  • DOI: https://doi.org/10.1007/s12288-020-01386-6

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