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Equivalent outcomes using reduced intensity or conventional myeloablative conditioning transplantation for patients aged 35 years and over with AML

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Abstract

Allogeneic hematopoietic stem cell transplantation provides the best chance of long-term survival for patients with AML, but is associated with an unpredictable risk of treatment-related mortality. From January 2000 to December 2010, we compared the outcomes for patients with AML aged 35 and over using reduced-intensity conditioning (RIC, N=60) or conventional myeloablative conditioning (MAC) regimen (N=72) transplantation. The median follow-up was 47 months (10–134). The 4-year cumulative incidence of non-relapse mortality was 21%. After adjusting for cytogenetic risk, gender donor/recipient mismatch and CD34+ cells, non-relapse mortality was significantly lower with the RIC regimen (P=0.027). The 4-year cumulative incidence of relapse was 38% and no difference was observed in the adjusted relapse rate between the two groups. The 4-year OS rate was 46%. Using both Cox regression and inverse probability-of-treatment weighted (IPTW) method, a similar OS rate was found with both regimens (adjusted hazard ratios for conventional vs reduced of 1.14 (95% CI 0.67–1.93, P=0.64) with Cox regression, and 1.14 (95% CI 0.55–2.34, P=0.73) with IPTW). Until prospective trials are completed, this study supports the use of a reduced-intensity regimen prior to transplantation for patients with AML aged 35 and over.

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Author notes

  1. G Socié and R P de Latour: These authors contributed equally to the study and should be considered as senior co-authors.

Authors and Affiliations

  1. Service d’Hématologie Sénior, Hôpital Saint Louis, Paris, France

    M Sébert, L Adès & P Fenaux

  2. Service d’Hématologie Greffe, Hôpital Saint Louis, Paris, France

    M Sébert, M Robin, A Xhaard, N Dhedin, G Socié & R P de Latour

  3. Département de Biostatistiques et d’Informatique Médicale, Hôpital Saint Louis, Paris, France

    R Porcher

  4. Service d’Hématologie Clinique, Hôpital Avicenne, Bobigny, France

    L Adès & P Fenaux

  5. Service d’Hématologie Clinique, Hôpital Saint Louis, Paris, France,

    N Boissel, E Raffoux & H Dombret

  6. AP-HP, Hôpital Saintl-Louis, Unité de Thérapie Cellulaire et CIC de biothérapies, Paris, France

    J Larghero

  7. Université Paris Diderot, Paris, France

    J Larghero

  8. Service d’Hématologie Clinique, Reims, France

    C Himberlin & A Delmer

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  1. M Sébert
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Correspondence to R P de Latour.

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Sébert, M., Porcher, R., Robin, M. et al. Equivalent outcomes using reduced intensity or conventional myeloablative conditioning transplantation for patients aged 35 years and over with AML. Bone Marrow Transplant 50, 74–81 (2015). https://doi.org/10.1038/bmt.2014.199

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  • DOI: https://doi.org/10.1038/bmt.2014.199

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