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Allogeneic Stem Cell Transplantation in Patients >40 Years of Age With Acute Lymphoblastic Leukemia: Reduced Intensity Versus Myeloablative Conditioning.
- Source :
-
Transplantation [Transplantation] 2023 Dec 01; Vol. 107 (12), pp. 2561-2567. Date of Electronic Publication: 2023 Jun 30. - Publication Year :
- 2023
-
Abstract
- Background: The outcome in older patients with acute lymphoblastic leukemia (ALL) remains unsatisfactory due to high relapse and nonrelapse mortality (NRM) rates. Allogeneic stem cell transplantation (alloHSCT) as postremission therapy has an important role in reducing relapse rate, albeit its application is limited in older adult patients due to alloHSCT-related morbidity and mortality. Reduced-intensity conditioning (RIC) alloHSCT has been developed as a less toxic conditioning regimen, but comparative studies with myeloablative conditioning (MAC) are limited in patients with ALL.<br />Methods: In this retrospective study, RIC-alloHSCT (n = 111) was compared with MAC-alloHSCT (n = 77) in patients aged 41 to 65 y with ALL in first complete remission. MAC was predominantly applied by combining high-dose total body irradiation and cyclophosphamide, whereas RIC mainly consisted of fludarabine and 2 Gy total body irradiation.<br />Results: Unadjusted overall survival was 54% (95% confidence interval [CI], 42%-65%) at 5 y in MAC recipients compared with 39% (95% CI, 29%-49%) in RIC recipients. Overall survival and relapse-free survival were not significantly associated with type of conditioning after adjusted for the covariates age, leukemia risk status at diagnosis, donor type, and donor and recipient gender combination. NRM was significantly lower after RIC (subdistribution hazard ratio: 0.41, 95% CI, 0.22-0.78; P = 0.006), whereas relapse was significantly higher (subdistribution hazard ratio: 3.04, 95% CI, 1.71-5.40; P < 0.001).<br />Conclusions: Collectively, RIC-alloHSCT has resulted in less NRM, but it was also found to be associated with a significantly higher relapse rate. These results suggest that MAC-alloHSCT may provide a more effective type of consolidation therapy for the reduction of relapse and that RIC-alloHSCT may be restricted to patients at higher risk for NRM.<br />Competing Interests: The authors declare no funding or conflicts of interest.<br /> (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)
- Subjects :
- Humans
Aged
Adult
Retrospective Studies
Recurrence
Transplantation Conditioning adverse effects
Transplantation Conditioning methods
Graft vs Host Disease epidemiology
Graft vs Host Disease etiology
Graft vs Host Disease prevention & control
Hematopoietic Stem Cell Transplantation methods
Precursor Cell Lymphoblastic Leukemia-Lymphoma therapy
Leukemia, Myeloid, Acute
Subjects
Details
- Language :
- English
- ISSN :
- 1534-6080
- Volume :
- 107
- Issue :
- 12
- Database :
- MEDLINE
- Journal :
- Transplantation
- Publication Type :
- Academic Journal
- Accession number :
- 37389645
- Full Text :
- https://doi.org/10.1097/TP.0000000000004706