Abstract
Objective:Allogeneic hematopoietic stem cell transplantation (HSCT) is an effective treatment modality for a variety of malignant and non-malignant hematologic disorders. Myeloablative conditioning (MAC) and reduced-intensity conditioning (RIC) regimens could have different clinical outcomes. This purpose of this study was to assess the long-term outcome of MAC versus RIC regimens in patients with acute myeloid leukemia (AML) undergoing allogeneic HSCT.Materials and Methods:We retrospectively compared long-term outcomes with MAC and RIC regimens in patients with AML who underwent allo-HSCT at our tertiary transplantation center.Results:We analyzed survival outcomes after MAC-HSCT versus RICHSCT among 107 adult patients with AML diagnosed from 2001 through 2017. Of those, 44 patients underwent a MAC regimen, whereas 63 patients received a RIC regimen. The median follow-up time was 37 months (range: 6-210) for the entire group. The 3-year overall survival (OS) for RIC and MAC patients was 67% and 60%, respectively (p>0.05). The 3-year progression-free survival (PFS) for RIC and MAC patients was 88% and 77%. In multivariate analysis, the type of conditioning regimen (RIC vs. MAC) did not influence PFS (p=0.24). Acute graft-versus-host disease (GVHD) was seen in five of the RIC patients and 9 of the MAC patients. Chronic GVHD was seen in 16 of the RIC patients and 6 of the MAC patients. There was no significant difference between the two groups in terms of acute GVHD (p=0.089), but there was a significant difference between the two groups in terms of chronic GVHD (p=0.03).Conclusion:This retrospective analysis confirmed that MAC and RIC regimens had a consistently equivalent rate of OS and PFS in AML patients who underwent allo-HSCT. The choice of MAC versus RIC conditioning regimen might be decided on the basis of patient and disease characteristics.
Highlights
Allogeneic hematopoietic stem cell transplantation is a therapy with curative potential in patients with acute myeloid leukemia (AML) as well as other hematologic neoplastic disorders [1]
This retrospective analysis confirmed that Myeloablative conditioning (MAC) and reduced-intensity conditioning (RIC) regimens had a consistently equivalent rate of overall survival (OS) and progression-free survival (PFS) in AML patients who underwent allo-hematopoietic stem cell transplantation (HSCT)
The choice of MAC versus RIC conditioning regimen might be decided on the basis of patient and disease characteristics
Summary
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a therapy with curative potential in patients with acute myeloid leukemia (AML) as well as other hematologic neoplastic disorders [1]. Disease status at the time of allo-HSCT, donor type, cytogenetics of the AML patients, and hematopoietic cell transplantation (HCT)-comorbidity index contribute to the outcome variables in both myeloablative conditioning (MAC) and reduced-intensity conditioning (RIC) [5]. Several previous studies comparing the survival outcomes of RIC and MAC allo-HSCT in AML patients have reported contradictory results. We retrospectively compared long-term outcomes of AML patients who received MAC and RIC regimens for allo-HSCT at our tertiary transplantation center. We analyzed the patient characteristics, disease and transplantation characteristics, and incidences of acute and chronic graft-versus-host disease (GVHD). It gives insight about the almost equivalent efficacy of RIC allo-HSCT in comparison to MAC allo-HSCT
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