Impact of conditioning intensity on outcomes of haploidentical stem cell transplantation for patients with acute myeloid leukemia 45 years of age and over

Nicole Santoro, Myriam Labopin, Fabio Ciceri, Maria Teresa Van Lint, Daniela Nasso, Didier Blaise, William Arcese, Johanna Tischer, Benedetto Bruno, Gerhard Ehninger, Yener Koc, Stella Santarone, Xiao Jun Huang, Bipin N. Savani, Mohamad Mohty, Annalisa Ruggeri, Arnon Nagler

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: T cell–replete haploidentical stem cell transplantation (haplo-SCT) is a valid therapeutic option for adult patients with high-risk acute myeloid leukemia (AML) lacking an HLA-matched sibling or unrelated donor. Method: We retrospectively analyzed the outcomes of 912 AML patients ≥45 years of age who had undergone haplo-SCT with either myeloablative conditioning (MAC; n = 373) or reduced intensity conditioning (RIC; n = 539) regimens. Results: The median follow-up was 31.1 and 25.7 months for MAC and RIC, respectively. The incidence of relapse and nonrelapse mortality (NRM) were 25.1% versus 28.7% and 31.0% versus 30.3% for MAC and RIC, respectively; 2-year leukemia-free survival (LFS) was 43.9% for MAC versus 41.0% for RIC. In multivariate analysis, the use of MAC versus RIC was not associated with a difference in the outcomes. Results were confirmed in the propensity score–weighted analysis. Disease status and performance status at transplantation were associated with outcomes. Notably, the use of posttransplantation cyclophosphamide was associated with reduced acute graft-versus-host disease (aGVHD) stage III-IV, and NRM and increased overall survival, LFS, and GVHD-free, relapse-free survival. The use of mobilized peripheral blood stem cells was associated with an increased risk of stage II-IV aGVHD. Conclusion: No differences were found between MAC and RIC regimens for haplo-SCT in adults with AML who were ≥45 years of age. The type of GVHD prophylaxis, disease status, and performance status were the major predictors of transplantation outcome. These results may serve as the background for randomized study comparing RIC versus MAC for haplo-SCT in adults with AML.

Original languageEnglish
Pages (from-to)1499-1506
Number of pages8
JournalCancer
Volume125
Issue number9
DOIs
Publication statusPublished - May 1 2019

Fingerprint

Stem Cell Transplantation
Acute Myeloid Leukemia
Survival
Graft vs Host Disease
Leukemia
Transplantation
Recurrence
Unrelated Donors
Mortality
Cyclophosphamide
Siblings
Multivariate Analysis
Conditioning (Psychology)
Incidence
Therapeutics

Keywords

  • acute myeloid leukemia
  • haploidentical stem cell transplantation
  • myeloablative conditioning
  • reduced intensity conditioning

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Impact of conditioning intensity on outcomes of haploidentical stem cell transplantation for patients with acute myeloid leukemia 45 years of age and over. / Santoro, Nicole; Labopin, Myriam; Ciceri, Fabio; Van Lint, Maria Teresa; Nasso, Daniela; Blaise, Didier; Arcese, William; Tischer, Johanna; Bruno, Benedetto; Ehninger, Gerhard; Koc, Yener; Santarone, Stella; Huang, Xiao Jun; Savani, Bipin N.; Mohty, Mohamad; Ruggeri, Annalisa; Nagler, Arnon.

In: Cancer, Vol. 125, No. 9, 01.05.2019, p. 1499-1506.

Research output: Contribution to journalArticle

Santoro, N, Labopin, M, Ciceri, F, Van Lint, MT, Nasso, D, Blaise, D, Arcese, W, Tischer, J, Bruno, B, Ehninger, G, Koc, Y, Santarone, S, Huang, XJ, Savani, BN, Mohty, M, Ruggeri, A & Nagler, A 2019, 'Impact of conditioning intensity on outcomes of haploidentical stem cell transplantation for patients with acute myeloid leukemia 45 years of age and over', Cancer, vol. 125, no. 9, pp. 1499-1506. https://doi.org/10.1002/cncr.31941
Santoro, Nicole ; Labopin, Myriam ; Ciceri, Fabio ; Van Lint, Maria Teresa ; Nasso, Daniela ; Blaise, Didier ; Arcese, William ; Tischer, Johanna ; Bruno, Benedetto ; Ehninger, Gerhard ; Koc, Yener ; Santarone, Stella ; Huang, Xiao Jun ; Savani, Bipin N. ; Mohty, Mohamad ; Ruggeri, Annalisa ; Nagler, Arnon. / Impact of conditioning intensity on outcomes of haploidentical stem cell transplantation for patients with acute myeloid leukemia 45 years of age and over. In: Cancer. 2019 ; Vol. 125, No. 9. pp. 1499-1506.
@article{e022b023333048f59d2810d5e97d9b32,
title = "Impact of conditioning intensity on outcomes of haploidentical stem cell transplantation for patients with acute myeloid leukemia 45 years of age and over",
abstract = "Background: T cell–replete haploidentical stem cell transplantation (haplo-SCT) is a valid therapeutic option for adult patients with high-risk acute myeloid leukemia (AML) lacking an HLA-matched sibling or unrelated donor. Method: We retrospectively analyzed the outcomes of 912 AML patients ≥45 years of age who had undergone haplo-SCT with either myeloablative conditioning (MAC; n = 373) or reduced intensity conditioning (RIC; n = 539) regimens. Results: The median follow-up was 31.1 and 25.7 months for MAC and RIC, respectively. The incidence of relapse and nonrelapse mortality (NRM) were 25.1{\%} versus 28.7{\%} and 31.0{\%} versus 30.3{\%} for MAC and RIC, respectively; 2-year leukemia-free survival (LFS) was 43.9{\%} for MAC versus 41.0{\%} for RIC. In multivariate analysis, the use of MAC versus RIC was not associated with a difference in the outcomes. Results were confirmed in the propensity score–weighted analysis. Disease status and performance status at transplantation were associated with outcomes. Notably, the use of posttransplantation cyclophosphamide was associated with reduced acute graft-versus-host disease (aGVHD) stage III-IV, and NRM and increased overall survival, LFS, and GVHD-free, relapse-free survival. The use of mobilized peripheral blood stem cells was associated with an increased risk of stage II-IV aGVHD. Conclusion: No differences were found between MAC and RIC regimens for haplo-SCT in adults with AML who were ≥45 years of age. The type of GVHD prophylaxis, disease status, and performance status were the major predictors of transplantation outcome. These results may serve as the background for randomized study comparing RIC versus MAC for haplo-SCT in adults with AML.",
keywords = "acute myeloid leukemia, haploidentical stem cell transplantation, myeloablative conditioning, reduced intensity conditioning",
author = "Nicole Santoro and Myriam Labopin and Fabio Ciceri and {Van Lint}, {Maria Teresa} and Daniela Nasso and Didier Blaise and William Arcese and Johanna Tischer and Benedetto Bruno and Gerhard Ehninger and Yener Koc and Stella Santarone and Huang, {Xiao Jun} and Savani, {Bipin N.} and Mohamad Mohty and Annalisa Ruggeri and Arnon Nagler",
year = "2019",
month = "5",
day = "1",
doi = "10.1002/cncr.31941",
language = "English",
volume = "125",
pages = "1499--1506",
journal = "Cancer",
issn = "0008-543X",
publisher = "John Wiley and Sons Inc.",
number = "9",

}

TY - JOUR

T1 - Impact of conditioning intensity on outcomes of haploidentical stem cell transplantation for patients with acute myeloid leukemia 45 years of age and over

AU - Santoro, Nicole

AU - Labopin, Myriam

AU - Ciceri, Fabio

AU - Van Lint, Maria Teresa

AU - Nasso, Daniela

AU - Blaise, Didier

AU - Arcese, William

AU - Tischer, Johanna

AU - Bruno, Benedetto

AU - Ehninger, Gerhard

AU - Koc, Yener

AU - Santarone, Stella

AU - Huang, Xiao Jun

AU - Savani, Bipin N.

AU - Mohty, Mohamad

AU - Ruggeri, Annalisa

AU - Nagler, Arnon

PY - 2019/5/1

Y1 - 2019/5/1

N2 - Background: T cell–replete haploidentical stem cell transplantation (haplo-SCT) is a valid therapeutic option for adult patients with high-risk acute myeloid leukemia (AML) lacking an HLA-matched sibling or unrelated donor. Method: We retrospectively analyzed the outcomes of 912 AML patients ≥45 years of age who had undergone haplo-SCT with either myeloablative conditioning (MAC; n = 373) or reduced intensity conditioning (RIC; n = 539) regimens. Results: The median follow-up was 31.1 and 25.7 months for MAC and RIC, respectively. The incidence of relapse and nonrelapse mortality (NRM) were 25.1% versus 28.7% and 31.0% versus 30.3% for MAC and RIC, respectively; 2-year leukemia-free survival (LFS) was 43.9% for MAC versus 41.0% for RIC. In multivariate analysis, the use of MAC versus RIC was not associated with a difference in the outcomes. Results were confirmed in the propensity score–weighted analysis. Disease status and performance status at transplantation were associated with outcomes. Notably, the use of posttransplantation cyclophosphamide was associated with reduced acute graft-versus-host disease (aGVHD) stage III-IV, and NRM and increased overall survival, LFS, and GVHD-free, relapse-free survival. The use of mobilized peripheral blood stem cells was associated with an increased risk of stage II-IV aGVHD. Conclusion: No differences were found between MAC and RIC regimens for haplo-SCT in adults with AML who were ≥45 years of age. The type of GVHD prophylaxis, disease status, and performance status were the major predictors of transplantation outcome. These results may serve as the background for randomized study comparing RIC versus MAC for haplo-SCT in adults with AML.

AB - Background: T cell–replete haploidentical stem cell transplantation (haplo-SCT) is a valid therapeutic option for adult patients with high-risk acute myeloid leukemia (AML) lacking an HLA-matched sibling or unrelated donor. Method: We retrospectively analyzed the outcomes of 912 AML patients ≥45 years of age who had undergone haplo-SCT with either myeloablative conditioning (MAC; n = 373) or reduced intensity conditioning (RIC; n = 539) regimens. Results: The median follow-up was 31.1 and 25.7 months for MAC and RIC, respectively. The incidence of relapse and nonrelapse mortality (NRM) were 25.1% versus 28.7% and 31.0% versus 30.3% for MAC and RIC, respectively; 2-year leukemia-free survival (LFS) was 43.9% for MAC versus 41.0% for RIC. In multivariate analysis, the use of MAC versus RIC was not associated with a difference in the outcomes. Results were confirmed in the propensity score–weighted analysis. Disease status and performance status at transplantation were associated with outcomes. Notably, the use of posttransplantation cyclophosphamide was associated with reduced acute graft-versus-host disease (aGVHD) stage III-IV, and NRM and increased overall survival, LFS, and GVHD-free, relapse-free survival. The use of mobilized peripheral blood stem cells was associated with an increased risk of stage II-IV aGVHD. Conclusion: No differences were found between MAC and RIC regimens for haplo-SCT in adults with AML who were ≥45 years of age. The type of GVHD prophylaxis, disease status, and performance status were the major predictors of transplantation outcome. These results may serve as the background for randomized study comparing RIC versus MAC for haplo-SCT in adults with AML.

KW - acute myeloid leukemia

KW - haploidentical stem cell transplantation

KW - myeloablative conditioning

KW - reduced intensity conditioning

UR - http://www.scopus.com/inward/record.url?scp=85059680875&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85059680875&partnerID=8YFLogxK

U2 - 10.1002/cncr.31941

DO - 10.1002/cncr.31941

M3 - Article

AN - SCOPUS:85059680875

VL - 125

SP - 1499

EP - 1506

JO - Cancer

JF - Cancer

SN - 0008-543X

IS - 9

ER -