1. Myeloablative vs reduced intensity T-cell-replete haploidentical transplantation for hematologic malignancy.
- Author
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Solomon, Scott, St Martin, Andrew, Shah, Nirav, Fatobene, Giancarlo, Al Malki, Monzr, Ballen, Karen, Bashey, Asad, Bejanyan, Nelli, Bolaños Meade, Javier, Brunstein, Claudio, DeFilipp, Zachariah, Champlin, Richard, Fuchs, Ephraim, Hamadani, Mehdi, Hematti, Peiman, Kanakry, Christopher, McGuirk, Joseph, McNiece, Ian, Ciurea, Stefan, Pasquini, Marcelo, Rocha, Vanderson, Romee, Rizwan, Patel, Sagar, Vasu, Sumithira, Waller, Edmund, Wingard, John, Zhang, Mei-Jie, and Eapen, Mary
- Subjects
Adolescent ,Adult ,Disease-Free Survival ,Female ,Hematologic Neoplasms ,Humans ,Middle Aged ,Myeloablative Agonists ,Transplantation Conditioning ,Transplantation ,Haploidentical ,Young Adult - 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.
- Published
- 2019