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 EBMTReportar como inadecuado

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 - Descarga este documento en PDF. Documentación en PDF para descargar gratis. Disponible también para leer online.

* Corresponding author 1 Service d-hématologie clinique et de thérapie cellulaire CHU Saint-Antoine 2 CR Saint-Antoine - Centre de Recherche Saint-Antoine 3 Acute Leukemia Working Party of EBMT 4 Vanderbilt University Nashville 5 EBMT - European Society for Blood and Marrow Transplantation 6 Ospedale San Raffaele 7 Ospedale San Martino 8 University of Rome -Tor Vergeta- 9 Medical Park Hospitals, Antalya 10 University Hospital Essen, University of Duisburg-Essen 11 Anadolu Medical Center Hospital 12 Department of Hematology - First Affiliated Hospital of Soochow University 13 Ospedale Civile BMT Center 14 Ludwig-Maximilians-Universität München 15 SPb State I. Pavlov 16 Klinikum Augsburg 17 Cancer Center Gliwice 18 Chaim Sheba Medical Center, Tel Aviv University 19 UPMC - Université Pierre et Marie Curie - Paris 6

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.

Keywords : Anti-leukemic effect Toxicity Haplo-identical donor Conditioning regimen Acute Leukemia Allogeneic stem cell transplantation

Autor: Marie T. Rubio - Bipin N Savani - Myriam Labopin - Simona Piemontese - Emmanuelle Polge - Fabio Ciceri - Andrea Bacigalupo - Will



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