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Inventi Impact: Transplantation

Articles

  • Inventi:hip/20054/16
    Impact of Conditioning Intensity in T-replete Haplo-identical Stem Cell Transplantation for Acute\nLeukemia: A Report from the Acute Leukemia Working Party of the EBMT
    01-Jan-1970 Research 2016 : July - September
    Marie T Rubio, Bipin N Savani, Myriam Labopin, Simona Piemontese, Emmanuelle Polge, Fabio Ciceri, Andrea Bacigalupo, William Arcese, Yener Koc, Dietrich Beelen, Zafer Gulbas, Depei Wu, Stella Santarone, Johanna Tischer, Boris Afanasyev, Christoph Schmid, Sebastian Giebel, Mohamad Mohty, Arnon Nagler

    Background: Increasing numbers of patients are receiving haplo-identical stem cell transplantation (haplo-SCT) for\ntreatment of acute leukemia with reduced intensity (RIC) or myeloablative (MAC) conditioning regimens. The impact of\nconditioning intensity in haplo-SCT is unknown.\nMethods: We performed a retrospective registry-based study comparing outcomes after T-replete haplo-SCT for\npatients with acute myeloid (AML) or lymphoid leukemia (ALL) after RIC (n = 271) and MAC (n = 425). Regimens were\nclassified as MAC or RIC based on published criteria.\nResults: A combination of post-transplant cyclophosphamide (PT-Cy) with one calcineurin inhibitor and mycophenolate\nmofetil (PT-Cy-based regimen) for graft-versus-host disease (GVHD) prophylaxis was used in 66 (25 %) patients in RIC and\n125 (32 %) in MAC groups. Patients of RIC group were older and had been transplanted more recently and more\nfrequently for AML with active disease at transplant. Percentage of engraftment (90 vs. 92 %; p = 0.58) and day\n100 grade II to IV acute GVHD (24 vs. 29 %, p = 0.23) were not different between RIC and MAC groups. Multivariable\nanalyses, run separately in AML and ALL, showed a trend toward higher relapse incidence with RIC in comparison to\nMAC in AML (hazard ratio (HR) 1.34, p = 0.09), and no difference in both AML and ALL in terms of non-relapse mortality\n(NRM) chronic GVHD and leukemia-free survival. There was no impact of conditioning regimen intensity in overall survival\n(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\noutcomes was disease status at transplantation (HR � 1.4, p � 0.01). GVHD prophylaxis with PT-Cy-based regimen was\nindependently associated with reduced NRM (HR 0.63, p = 0.02) without impact on relapse incidence (HR 0.99, p = 0.94).\nConclusions: These data suggest that T-replete haplo-SCT with both RIC and MAC, in particular associated with PT-Cy,\nare valid options in first line treatment of high risk AML or ALL.

    How to Cite this Article
    CC Compliant Citation: Rubio, Marie T., et al. \"Impact of\nconditioning intensity in T-replete haplo-identical stem cell\ntransplantation for acute leukemia: a report from the acute\nleukemia working party of the EBMT.\" Journal of hematology &\noncology 9.1 (2016): 1, DOI 10.1186/s13045-016-0248-3, http://\ncreativecommons.org/licenses/by/4.0/.
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