Redefining and measuring transplant conditioning intensity in current era: a study in acute myeloid leukemia patients: Bone Marrow Transplantation

A. Spyridonidis, M. Labopin, B.N. Savani, R. Niittyvuopio, D. Blaise, C. Craddock, G. Socié, U. Platzbecker, D. Beelen, N. Milpied, J.J. Cornelissen, A. Ganser, A. Huynh, L. Griskevicius, S. Giebel, M. Aljurf, E. Brissot, F. Malard, J. Esteve, Z. PericF. Baron, A. Ruggeri, C. Schmid, M. Gilleece, N.-C. Gorin, F. Lanza, R. Shouval, J. Versluis, G. Bug, Y. Fløisand, F. Ciceri, J. Sanz, A. Bazarbachi, A. Nagler, M. Mohty

Research output: Contribution to journalArticlepeer-review


To address limitations of the currently used reduced-intensity/myeloablative conditioning (RIC/MAC) classification scheme we aimed to develop a tool that can capture more standardized the conditioning intensity of allogeneic hematopoietic cell transplantation (HCT). We assigned intensity weight scores for frequently used conditioning regimen components and used their sum to generate the transplant conditioning intensity (TCI) score. We retrospectively tested the impact of TCI on 8255 adult (45–65 years) acute myeloid leukemia patients who underwent HCT in first complete remission. A Cox model for early nonrelapse mortality (NRM) yielded a 3-group TCI risk scheme (low, intermediate, high) with respective TCI scores of [1–2], [2.5–3.5] and [4–6]. On multivariate modeling, TCI grouping was highly and better predictive for early (day 100 and 180) NRM, 2-year NRM and relapse (REL) as compared with the RIC/MAC classification. Validation was done on 200 bootstrap samples. Moreover, TCI scoring enabled the identification of a distinct subgroup of RIC and MAC conditioning regimens with an intermediate TCI [2.5–3.5] score that had identical outcomes and which are frequently referred as “reduced toxicity conditioning”. TCI scheme provides an improvement of the RIC/MAC classification. We propose TCI as a new tool to define and measure the conditioning regimen intensity. © 2020, The Author(s), under exclusive licence to Springer Nature Limited.
Original languageEnglish
Pages (from-to)1114-1125
Number of pages12
JournalBone Marrow Transplant.
Issue number6
Publication statusPublished - 2020


  • busulfan
  • carmustine
  • clofarabine
  • cyclophosphamide
  • cytarabine
  • etoposide
  • fludarabine
  • melphalan
  • thiotepa
  • treosulfan
  • acute graft versus host disease
  • acute myeloid leukemia
  • adult
  • aged
  • allogeneic hematopoietic stem cell transplantation
  • Article
  • bootstrap cross validation
  • cancer mortality
  • cancer patient
  • chronic graft versus host disease
  • clinical classification
  • cohort analysis
  • controlled study
  • female
  • human
  • intermethod comparison
  • leukemia relapse
  • leukemia remission
  • major clinical study
  • male
  • myeloablative conditioning
  • outcome assessment
  • priority journal
  • reduced intensity conditioning
  • retrospective study
  • risk assessment
  • scoring system
  • whole body radiation


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