Myeloablative vs reduced-intensity conditioning allogeneic hematopoietic cell transplantation for chronic myeloid leukemia

• Type of Material: Article
• Authors: Saurabh Chhabra, Medical College of Wisconsin; Kwang Woo Ahn, Medical College of Wisconsin; Zhen-Huan Hu, Medical College of Wisconsin; Sandeep Jain, Medical University of South Carolina; H Jean Khoury, Emory University
• Language: English
• Date: 2018-11-13
• Publisher: American Society of Hematology
• Publication Version: Final Published Version
• Copyright Statement: © 2018 The American Society of Hematology.
• Final Published Version (URL): http://dx.doi.org/10.1182/bloodadvances.2018024844
• Title of Journal or Parent Work: Blood Advances
• Volume: 2
• Issue: 21
• Start Page: 2922
• End Page: 2936
• Grant/Funding Information: The CIBMTR is supported primarily by the National Institutes of Health (public health service grant/cooperative agreement 5U24CA076518 from the National Cancer Institute, National Heart, Lung, and Blood Institute, and National Institute of Allergy and Infectious Diseases and grant/cooperative agreement 4U10HL069294 from the National Heart, Lung, and Blood Institute and National Cancer Institute), the Health Resources and Services Administration/Department of Health and Human Services (contract HHSH250201200016C), and the Office of Naval Research (grants N00014-17-1-2388 and N0014-17-1-2850); The views expressed in this article do not reflect the official policy or position of the National Institutes of Health, Department of the Navy, Department of Defense, Health Resources and Services Administration, or any other agency of the US Government.
• Keywords: MARROW-TRANSPLANTATION; WORKING PARTY; Hematology; UNRELATED DONOR TRANSPLANTATION; CHROMOSOME-POSITIVE LEUKEMIA; VERSUS-HOST-DISEASE; ACUTE LYMPHOBLASTIC-LEUKEMIA; TYROSINE KINASE; CHRONIC MYELOGENOUS LEUKEMIA; BONE-MARROW; CHRONIC GRAFT; Life Sciences & Biomedicine; Science & Technology

Abstract

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.