Premium
Conventional versus reduced‐intensity conditioning regimen for allogeneic stem cell transplantation in patients with hematological malignancies
Author(s) -
Valcárcel D.,
Martino R.,
Sureda A.,
Canals C.,
Altés A.,
Briones J.,
Sanz M. A.,
Parody R.,
Constans M.,
Villela S. L.,
Brunet S.,
Sierra J.
Publication year - 2005
Publication title -
european journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 84
eISSN - 1600-0609
pISSN - 0902-4441
DOI - 10.1111/j.1600-0609.2004.00360.x
Subject(s) - medicine , transplantation , cumulative incidence , hematopoietic stem cell transplantation , incidence (geometry) , regimen , surgery , sibling , gastroenterology , psychology , developmental psychology , physics , optics
Background: Allogeneic hematopoietic stem cell transplantation (HSCT) from human leukocyte antigen (HLA)‐compatible sibling donors is a potential curative treatment for hematological and non‐hematological malignancies. Nevertheless, high mortality rates may be associated with this therapy, especially in older patients, those with other comorbidities or who receive a second HSCT. Patients and methods: We analyzed the factors associated with transplant‐related mortality (TRM) and overall survival in 157 consecutive adult patients (104 males and 53 females) who received a HSCT [29 bone marrow (BM) transplantation and 128 peripheral blood (PB) transplantation] from a HLA‐identical sibling between January 1995 and March 2002 in our institution. One hundred patients received a standard conditioning prior to HSCT (STAND) and 57 patients received a reduced‐intensity conditioning (RIC) HSCT. Fifty‐eight patients were in an early phase at transplant and 99 in a non‐early phase. Median age was 46 yr (16–66), and 90 patients (57%) were >45 yr of age. Results: Patients in the RIC group were older than those in the STAND group, and had a higher proportion of non‐early disease phases including a prior autologous HSCT in 39%. Median follow‐up for survivors was 28 and 15 months in the STAND and RIC groups ( P < 0,001), respectively. Cumulative incidence of TRM at 2 yr was 30% [95% confidence interval (CI) 22–41%] for the STAND group and 22% (95% CI 13–37%) for the RIC group [non‐significant (NS)]. Factors associated with a higher TRM in multivariate analysis were: STAND vs. RIC conditioning regimen [relative risk (RR) 5.4; 95% CI 2.3–12.8; P < 0.001]; age ≥45 yr vs. <45 yr (RR 5; 95% CI 2.4–10.8, P < 0.001); second vs. first HSCT (RR 2.8, 95% CI 1.3–6.3, P = 0.01) and non‐T‐cell‐depleted vs. T‐cell‐depleted graft (RR 2.7, 95% CI 1.3–5.8, P = 0.009). Overall survival (OS) at 2 yr was 52.5 ± 10.4% for STAND group and 59 ± 16.8% in RIC group. Factors associated with poorer OS in multivariate analysis were: STAND vs. RIC conditioning regimen (RR 3.4, 95% CI 1.7–6.9, P = 0.001); age ≥45 vs <45 yr (RR 2.5, 95% CI 1.4–4.5, P = 0.002) and diagnosis [other than chronic myeloid leukemia (CML) vs. CML] (RR 2.6, 95% CI 1.2–5.7 P = 0.02). Conclusions: Our results indicate that the introduction of RIC allogeneic HSCT for patients at high risk for TRM (advanced age, prior HSCT and non‐T‐cell depletion) leads to a reduction in the TRM and improvement in the OS.