Although reduced-intensity conditioning (RIC) and non-myeloablative (NMA)-conditioning regimens have been used for over a decade, their relative efficacy vs myeloablative (MA) approaches to allogeneic hematopoietic cell transplantation in patients with AML and myelodysplasia (MDS) is unknown. We compared disease status, donor, graft and recipient characteristics with outcomes of 3731 MA with 1448 RIC/NMA procedures performed at 217 centers between 1997 and 2004. The 5-year univariate probabilities and multivariate relative risk outcomes of relapse, TRM, disease-free survival (DFS) and OS are reported. Adjusted OS at 5 years was 34, 33 and 26% for MA, RIC and NMA transplants, respectively. NMA conditioning resulted in inferior DFS and OS, but there was no difference in DFS and OS between RIC and MA regimens. Late TRM negates early decreases in toxicity with RIC and NMA regimens. Our data suggest that higher regimen intensity may contribute to optimal survival in patients with AML/MDS, suggesting roles for both regimen intensity and graft vs leukemia in these diseases. Prospective studies comparing regimens are needed to confirm this finding and determine the optimal approach to patients who are eligible for either MA or RIC/NMA conditioning.
Bibliographical noteFunding Information:
The CIBMTR is supported by Public Health Service Grant/ Cooperative Agreement U24-CA76518 from the National Cancer Institute (NCI), the National Heart, Lung and Blood Institute (NHLBI) and the National Institute of Allergy and Infectious Diseases; a grant/cooperative agreement 5U01HL069294 from NHLBI and NCI; a contract HHSH234200637015C with Health Resources and Services Administration (HRSA/DHHS); two grants N00014-06-1-0704 and N00014-08-1-0058 from the Office of Naval Research; grants from AABB; Aetna; American Society for Blood and Marrow Transplantation; Amgen Inc.; anonymous donation to the Medical College of Wisconsin; Astellas Pharma US Inc.; Baxter International Inc.; Bayer HealthCare Pharmaceuticals; Be the Match Foundation; Biogen IDEC; BioMarin Pharmaceutical Inc.; Biovitrum AB; Blood Center of Wisconsin; Blue Cross and Blue Shield Association; Bone Marrow Foundation; Canadian Blood and Marrow Transplant Group; CaridianBCT; Celgene Corporation; CellGenix, GmbH; Centers for Disease Control and Prevention; Children’s Leukemia Research Association; ClinImmune Labs; CTI Clinical Trial and Consulting Services; Cubist Pharmaceuticals; Cylex Inc.; CytoTherm; DOR BioPharma Inc.; Dynal Biotech, an Invitrogen Company; Eisai Inc.; Enzon Pharmaceuticals Inc.; European Group for Blood and Marrow Transplantation; Gamida Cell Ltd; GE Healthcare; Genentech Inc.; Genzyme Corporation; Histogenetics Inc.; HKS Medical Information Systems; Hospira Inc.; Infectious Diseases Society of America; Kiadis Pharma; Kirin Brewery Co. Ltd; The Leukemia & Lymphoma Society; Merck & Company; The Medical College of Wisconsin; MGI Pharma Inc.; Michigan Community Blood Centers; Millennium Pharmaceuticals Inc.; Miller Pharmacal Group; Milliman USA Inc.; Miltenyi Biotec Inc.; NMDP; Nature Publishing Group; New York Blood Center; Novartis Oncology; Oncology Nursing Society; Osiris Therapeutics Inc.; Otsuka America Pharmaceutical Inc.; Pall Life Sciences; Pfizer Inc.; Saladax Biomedical Inc.; Schering Corporation; Society for Healthcare Epidemiology of America; StemCyte Inc.; StemSoft Software Inc.; Sysmex America Inc.; Teva Pharmaceutical Industries; Therakos Inc.; Thermogenesis Corporation; Vidacare Corporation; Vion Pharmaceuticals Inc.; ViraCor Laboratories; ViroPharma Inc.; and Wellpoint Inc. The views expressed in this article do not reflect the official policy or position of the National Institute of Health, the Department of the Navy, the Department of Defense or any other agency of the US Government. We thank Karen Ballen, Willem Bujan, Steven Goldstein, Roger Herzig, Osman Ilhan, Luis Isola, Jane Liesveld, Gustavo Milone, David Rizzieri, James Russell, Mitchell Sabloff, Stella Santarone, Gary Schiller, Robert Soiffer, Edmund Waller, Roy Weiner and Peter Wiernik for helpful comments and insights.
- allogeneic transplant
- reduced intensity