Myeloablative vs reduced-intensity conditioning allogeneic hematopoietic cell transplantation for chronic myeloid leukemia

Saurabh Chhabra, Kwang Woo Ahn, Zhen Huan Hu, Sandeep Jain, Amer Assal, Jan Cerny, Edward A. Copelan, Andrew Daly, Zachariah DeFilipp, Shahinaz M. Gadalla, Robert Peter Gale, Siddhartha Ganguly, Betty K. Hamilton, Gerhard Carl Hildebrandt, Jack W. Hsu, Yoshihiro Inamoto, Abraham S. Kanate, H. Jean Khoury, Hillard M. Lazarus, Mark R. LitzowSunita Nathan, Richard F. Olsson, Attaphol Pawarode, Olle Ringden, Jacob M. Rowe, Ayman Saad, Bipin N. Savani, Harry C. Schouten, Sachiko Seo, Nirav N. Shah, Melhem Solh, Robert K. Stuart, Celalettin Ustun, Ann E. Woolfrey, Jean A. Yared, Edwin P. Alyea, Matt E. Kalaycio, Uday Popat, Ronald M. Sobecks, Wael Saber

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9 Scopus citations

Abstract

Allogeneic hematopoietic cell transplantation (allo-HCT) is a potentially curative treatment of chronic myeloid leukemia (CML). Optimal conditioning intensity for allo-HCT for CML in the era of tyrosine kinase inhibitors (TKIs) is unknown. Using the Center for International Blood and Marrow Transplant Research database, we sought to determine whether reduced-intensity/nonmyeloablative conditioning (RIC) allo-HCT and myeloablative conditioning (MAC) result in similar outcomes in CML patients. We evaluated 1395 CML allo-HCT recipients between the ages of 18 and 60 years. The disease status at transplant was divided into the following categories: chronic phase 1, chronic phase 2 or greater, and accelerated phase. Patients in blast phase at transplant and alternative donor transplants were excluded. The primary outcome was overall survival (OS) after allo-HCT. MAC (n = 1204) and RIC allo-HCT recipients (n = 191) from 2007 to 2014 were included. Patient, disease, and transplantation characteristics were similar, with a few exceptions. Multivariable analysis showed no significant difference in OS between MAC and RIC groups. In addition, leukemia-free survival and nonrelapse mortality did not differ significantly between the 2 groups. Compared with MAC, the RIC group had a higher risk of early relapse after allo-HCT (hazard ratio [HR], 1.85; P = .001). The cumulative incidence of chronic graft-versus-host disease (cGVHD) was lower with RIC than with MAC (HR, 0.77; P = .02). RIC provides similar survival and lower cGVHD compared with MAC and therefore may be a reasonable alternative to MAC for CML patients in the TKI era.

Original languageEnglish (US)
Pages (from-to)2922-2936
Number of pages15
JournalBlood Advances
Volume2
Issue number21
DOIs
StatePublished - Nov 13 2018

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ASJC Scopus subject areas

  • Hematology

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Chhabra, S., Ahn, K. W., Hu, Z. H., Jain, S., Assal, A., Cerny, J., Copelan, E. A., Daly, A., DeFilipp, Z., Gadalla, S. M., Gale, R. P., Ganguly, S., Hamilton, B. K., Hildebrandt, G. C., Hsu, J. W., Inamoto, Y., Kanate, A. S., Jean Khoury, H., Lazarus, H. M., ... Saber, W. (2018). Myeloablative vs reduced-intensity conditioning allogeneic hematopoietic cell transplantation for chronic myeloid leukemia. Blood Advances, 2(21), 2922-2936. https://doi.org/10.1182/bloodadvances.2018024844