Myeloablative vs reduced-intensity conditioning allogeneic hematopoietic cell transplantation for chronic myeloid leukemia.
Сравнительное исследованиеСтатьяПоддержка NIH: внешняя программаПоддержка исследования: вне правительства СШАПоддержка правительства СШАПоддержка службы здравоохранения СШАНазвание и аннотация: Перевод пока не подготовлен
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Chhabra Saurabh, Ahn Kwang Woo, Hu Zhen-Huan, Jain Sandeep, Assal Amer, Cerny Jan, Copelan Edward A, Daly Andrew, DeFilipp Zachariah, Gadalla Shahinaz M, Gale Robert Peter, Ganguly Siddhartha, Hamilton Betty K, Hildebrandt Gerhard Carl, Hsu Jack W, Inamoto Yoshihiro, Kanate Abraham S, Khoury H Jean, Lazarus Hillard M, Litzow Mark R, Nathan Sunita, Olsson Richard F, Pawarode Attaphol, Ringden Olle, Rowe Jacob M, Saad Ayman, Savani Bipin N, Schouten Harry C, Seo Sachiko, Shah Nirav N, Solh Melhem, Stuart Robert K, Ustun Celalettin, Woolfrey Ann E, Yared Jean A, Alyea Edwin P, Kalaycio Matt E, Popat Uday, Sobecks Ronald M, Saber Wael
Аннотация
Allogeneic hematopoietic cell transplantation (allo-HCT) is a potentially curative treatment of chronic myeloid leukemia (CML). Optimal conditioning intensity for allo-HCT for CML in the era of tyrosine kinase inhibitors (TKIs) is unknown. Using the Center for International Blood and Marrow Transplant Research database, we sought to determine whether reduced-intensity/nonmyeloablative conditioning (RIC) allo-HCT and myeloablative conditioning (MAC) result in similar outcomes in CML patients. We evaluated 1395 CML allo-HCT recipients between the ages of 18 and 60 years. The disease status at transplant was divided into the following categories: chronic phase 1, chronic phase 2 or greater, and accelerated phase. Patients in blast phase at transplant and alternative donor transplants were excluded. The primary outcome was overall survival (OS) after allo-HCT. MAC (n = 1204) and RIC allo-HCT recipients (n = 191) from 2007 to 2014 were included. Patient, disease, and transplantation characteristics were similar, with a few exceptions. Multivariable analysis showed no significant difference in OS between MAC and RIC groups. In addition, leukemia-free survival and nonrelapse mortality did not differ significantly between the 2 groups. Compared with MAC, the RIC group had a higher risk of early relapse after allo-HCT (hazard ratio [HR], 1.85; P = .001). The cumulative incidence of chronic graft-versus-host disease (cGVHD) was lower with RIC than with MAC (HR, 0.77; P = .02). RIC provides similar survival and lower cGVHD compared with MAC and therefore may be a reasonable alternative to MAC for CML patients in the TKI era.