Impact of conditioning intensity in T-replete haplo-identical stem cell transplantation for acute leukemia: a report from the acute leukemia working party of the EBMT
Abstract Background Increasing numbers of patients are receiving haplo-identical stem cell transplantation (haplo-SCT) for treatment of acute leukemia with reduced intensity (RIC) or myeloablative (MAC) conditioning regimens. The impact of conditioning intensity in haplo-SCT is unknown. Methods We p...
| Main Authors: | , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2016-03-01
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| Series: | Journal of Hematology & Oncology |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13045-016-0248-3 |
| _version_ | 1818851015640743936 |
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| author | Marie T. Rubio Bipin N. Savani Myriam Labopin Simona Piemontese Emmanuelle Polge Fabio Ciceri Andrea Bacigalupo William Arcese Yener Koc Dietrich Beelen Zafer Gülbas Depei Wu Stella Santarone Johanna Tischer Boris Afanasyev Christoph Schmid Sebastian Giebel Mohamad Mohty Arnon Nagler |
| author_facet | Marie T. Rubio Bipin N. Savani Myriam Labopin Simona Piemontese Emmanuelle Polge Fabio Ciceri Andrea Bacigalupo William Arcese Yener Koc Dietrich Beelen Zafer Gülbas Depei Wu Stella Santarone Johanna Tischer Boris Afanasyev Christoph Schmid Sebastian Giebel Mohamad Mohty Arnon Nagler |
| author_sort | Marie T. Rubio |
| collection | DOAJ |
| description | Abstract Background Increasing numbers of patients are receiving haplo-identical stem cell transplantation (haplo-SCT) for treatment of acute leukemia with reduced intensity (RIC) or myeloablative (MAC) conditioning regimens. The impact of conditioning intensity in haplo-SCT is unknown. Methods We performed a retrospective registry-based study comparing outcomes after T-replete haplo-SCT for patients with acute myeloid (AML) or lymphoid leukemia (ALL) after RIC (n = 271) and MAC (n = 425). Regimens were classified as MAC or RIC based on published criteria. Results A combination of post-transplant cyclophosphamide (PT-Cy) with one calcineurin inhibitor and mycophenolate mofetil (PT-Cy-based regimen) for graft-versus-host disease (GVHD) prophylaxis was used in 66 (25 %) patients in RIC and 125 (32 %) in MAC groups. Patients of RIC group were older and had been transplanted more recently and more frequently for AML with active disease at transplant. Percentage of engraftment (90 vs. 92 %; p = 0.58) and day 100 grade II to IV acute GVHD (24 vs. 29 %, p = 0.23) were not different between RIC and MAC groups. Multivariable analyses, run separately in AML and ALL, showed a trend toward higher relapse incidence with RIC in comparison to MAC in AML (hazard ratio (HR) 1.34, p = 0.09), and no difference in both AML and ALL in terms of non-relapse mortality (NRM) chronic GVHD and leukemia-free survival. There was no impact of conditioning regimen intensity in overall survival (OS) in AML (HR = 0.97, p = 0.79) but a trend for worse OS with RIC in ALL (HR = 1.44, p = 0.10). The main factor impacting outcomes was disease status at transplantation (HR ≥ 1.4, p ≤ 0.01). GVHD prophylaxis with PT-Cy-based regimen was independently associated with reduced NRM (HR 0.63, p = 0.02) without impact on relapse incidence (HR 0.99, p = 0.94). Conclusions These data suggest that T-replete haplo-SCT with both RIC and MAC, in particular associated with PT-Cy, are valid options in first line treatment of high risk AML or ALL. |
| first_indexed | 2024-12-19T06:58:18Z |
| format | Article |
| id | doaj.art-fcbef71facf44de5922549fccfc05e79 |
| institution | Directory Open Access Journal |
| issn | 1756-8722 |
| language | English |
| last_indexed | 2024-12-19T06:58:18Z |
| publishDate | 2016-03-01 |
| publisher | BMC |
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| series | Journal of Hematology & Oncology |
| spelling | doaj.art-fcbef71facf44de5922549fccfc05e792022-12-21T20:31:29ZengBMCJournal of Hematology & Oncology1756-87222016-03-019111210.1186/s13045-016-0248-3Impact of conditioning intensity in T-replete haplo-identical stem cell transplantation for acute leukemia: a report from the acute leukemia working party of the EBMTMarie T. Rubio0Bipin N. Savani1Myriam Labopin2Simona Piemontese3Emmanuelle Polge4Fabio Ciceri5Andrea Bacigalupo6William Arcese7Yener Koc8Dietrich Beelen9Zafer Gülbas10Depei Wu11Stella Santarone12Johanna Tischer13Boris Afanasyev14Christoph Schmid15Sebastian Giebel16Mohamad Mohty17Arnon Nagler18Service d’Hématologie et de Thérapie cellulaire, Saint Antoine HospitalAcute Leukemia Working Party of EBMTService d’Hématologie et de Thérapie cellulaire, Saint Antoine HospitalAcute Leukemia Working Party of EBMTService d’Hématologie et de Thérapie cellulaire, Saint Antoine HospitalOspedale San Raffaele s.r.l.Department of Haematology II, Ospedale San MartinoRome Transplant Network, Stem Cell Transplant Unit, Tor Vergata UniversityStem Cell Transplant Unit, Medical Park HospitalsDepartment of Bone Marrow Transplantation, University HospitalBone Marrow Transplantation Department, Anadolu Medical Center HospitalDepartment of Hematology, First Affiliated Hospital of Soochow UniversityOspedale Civile BMT CenterDepartment of Internal Medicine III, Ludwig-Maximilians-University Hospital of Munich-GrosshadernSPb State I. Pavlov Medical UniversityKlinikum Augsburg, University of MunichDepartment of Bone Marrow Transplantation and Hemato-Oncology, Cancer CenterService d’Hématologie et de Thérapie cellulaire, Saint Antoine HospitalUniversité Pierre et Marie CurieAbstract Background Increasing numbers of patients are receiving haplo-identical stem cell transplantation (haplo-SCT) for treatment of acute leukemia with reduced intensity (RIC) or myeloablative (MAC) conditioning regimens. The impact of conditioning intensity in haplo-SCT is unknown. Methods We performed a retrospective registry-based study comparing outcomes after T-replete haplo-SCT for patients with acute myeloid (AML) or lymphoid leukemia (ALL) after RIC (n = 271) and MAC (n = 425). Regimens were classified as MAC or RIC based on published criteria. Results A combination of post-transplant cyclophosphamide (PT-Cy) with one calcineurin inhibitor and mycophenolate mofetil (PT-Cy-based regimen) for graft-versus-host disease (GVHD) prophylaxis was used in 66 (25 %) patients in RIC and 125 (32 %) in MAC groups. Patients of RIC group were older and had been transplanted more recently and more frequently for AML with active disease at transplant. Percentage of engraftment (90 vs. 92 %; p = 0.58) and day 100 grade II to IV acute GVHD (24 vs. 29 %, p = 0.23) were not different between RIC and MAC groups. Multivariable analyses, run separately in AML and ALL, showed a trend toward higher relapse incidence with RIC in comparison to MAC in AML (hazard ratio (HR) 1.34, p = 0.09), and no difference in both AML and ALL in terms of non-relapse mortality (NRM) chronic GVHD and leukemia-free survival. There was no impact of conditioning regimen intensity in overall survival (OS) in AML (HR = 0.97, p = 0.79) but a trend for worse OS with RIC in ALL (HR = 1.44, p = 0.10). The main factor impacting outcomes was disease status at transplantation (HR ≥ 1.4, p ≤ 0.01). GVHD prophylaxis with PT-Cy-based regimen was independently associated with reduced NRM (HR 0.63, p = 0.02) without impact on relapse incidence (HR 0.99, p = 0.94). Conclusions These data suggest that T-replete haplo-SCT with both RIC and MAC, in particular associated with PT-Cy, are valid options in first line treatment of high risk AML or ALL.http://link.springer.com/article/10.1186/s13045-016-0248-3Allogeneic stem cell transplantationHaplo-identical donorConditioning regimenAcute LeukemiaToxicityAnti-leukemic effect |
| spellingShingle | Marie T. Rubio Bipin N. Savani Myriam Labopin Simona Piemontese Emmanuelle Polge Fabio Ciceri Andrea Bacigalupo William Arcese Yener Koc Dietrich Beelen Zafer Gülbas Depei Wu Stella Santarone Johanna Tischer Boris Afanasyev Christoph Schmid Sebastian Giebel Mohamad Mohty Arnon Nagler Impact of conditioning intensity in T-replete haplo-identical stem cell transplantation for acute leukemia: a report from the acute leukemia working party of the EBMT Journal of Hematology & Oncology Allogeneic stem cell transplantation Haplo-identical donor Conditioning regimen Acute Leukemia Toxicity Anti-leukemic effect |
| title | Impact of conditioning intensity in T-replete haplo-identical stem cell transplantation for acute leukemia: a report from the acute leukemia working party of the EBMT |
| title_full | Impact of conditioning intensity in T-replete haplo-identical stem cell transplantation for acute leukemia: a report from the acute leukemia working party of the EBMT |
| title_fullStr | Impact of conditioning intensity in T-replete haplo-identical stem cell transplantation for acute leukemia: a report from the acute leukemia working party of the EBMT |
| title_full_unstemmed | Impact of conditioning intensity in T-replete haplo-identical stem cell transplantation for acute leukemia: a report from the acute leukemia working party of the EBMT |
| title_short | Impact of conditioning intensity in T-replete haplo-identical stem cell transplantation for acute leukemia: a report from the acute leukemia working party of the EBMT |
| title_sort | impact of conditioning intensity in t replete haplo identical stem cell transplantation for acute leukemia a report from the acute leukemia working party of the ebmt |
| topic | Allogeneic stem cell transplantation Haplo-identical donor Conditioning regimen Acute Leukemia Toxicity Anti-leukemic effect |
| url | http://link.springer.com/article/10.1186/s13045-016-0248-3 |
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