TY - JOUR
T1 - Is there an optimal conditioning for older patients with AML receiving allogeneic hematopoietic cell transplantation?
AU - Ciurea, Stefan O.
AU - Kongtim, Piyanuch
AU - Varma, Ankur
AU - Rondon, Gabriela
AU - Chen, Julianne
AU - Srour, Samer
AU - Bashir, Qaiser
AU - Alousi, Amin
AU - Mehta, Rohtesh
AU - Oran, Betul
AU - Popat, Uday
AU - Hosing, Chitra
AU - Olson, Amanda
AU - Daver, Naval
AU - Konopleva, Marina
AU - Champlin, Richard E.
N1 - Publisher Copyright:
© 2020 American Society of Hematology. All rights reserved.
PY - 2020/2/6
Y1 - 2020/2/6
N2 - The optimal conditioning regimen for older patients with acute myeloid leukemia (AML) remains unclear. In this study, we compared outcomes of AML patients >60 years of age undergoing allogenic hematopoietic stem cell transplantation at our institution. All 404 consecutively treated patients received 1 of the following conditioning regimens: (1) fludarabine1melphalan 100 mg/m2 (FM100), (2) fludarabine1melphalan 140 mg/m2 (FM140), (3) fludarabine1IV busulfan AUC 5000/d 3 4 d (Bu 20000), and (4) fludarabine1 IV busulfan AUC 4000/d 3 4 d (Bu16000). A propensity score analysis (PSA) was used to compare outcomes between these 4 groups. Among the 4 conditioning regimens, the FM100 group had a significantly better long-term survival with 5-year progression-free survival of 49% vs 30%, 34%, and 23%, respectively. The benefit of the FM100 regimen resulted primarily from the lower nonrelapse mortality associated with this regimen, an effect more pronounced in patients with lower performance status. The PSA confirmed that FM100 was associated with better posttransplantation survival, whereas no significant differences were seen between the other regimen groups. In summary, older patients with AML benefited from a reduced-intensity conditioning regimen with lower melphalan doses (FM100), which was associated with better survival, even though it was primarily used in patients who could not receive a more intense conditioning regimen.
AB - The optimal conditioning regimen for older patients with acute myeloid leukemia (AML) remains unclear. In this study, we compared outcomes of AML patients >60 years of age undergoing allogenic hematopoietic stem cell transplantation at our institution. All 404 consecutively treated patients received 1 of the following conditioning regimens: (1) fludarabine1melphalan 100 mg/m2 (FM100), (2) fludarabine1melphalan 140 mg/m2 (FM140), (3) fludarabine1IV busulfan AUC 5000/d 3 4 d (Bu 20000), and (4) fludarabine1 IV busulfan AUC 4000/d 3 4 d (Bu16000). A propensity score analysis (PSA) was used to compare outcomes between these 4 groups. Among the 4 conditioning regimens, the FM100 group had a significantly better long-term survival with 5-year progression-free survival of 49% vs 30%, 34%, and 23%, respectively. The benefit of the FM100 regimen resulted primarily from the lower nonrelapse mortality associated with this regimen, an effect more pronounced in patients with lower performance status. The PSA confirmed that FM100 was associated with better posttransplantation survival, whereas no significant differences were seen between the other regimen groups. In summary, older patients with AML benefited from a reduced-intensity conditioning regimen with lower melphalan doses (FM100), which was associated with better survival, even though it was primarily used in patients who could not receive a more intense conditioning regimen.
UR - http://www.scopus.com/inward/record.url?scp=85078412655&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85078412655&partnerID=8YFLogxK
U2 - 10.1182/blood.2019003662
DO - 10.1182/blood.2019003662
M3 - Article
C2 - 31826244
AN - SCOPUS:85078412655
SN - 0006-4971
VL - 135
SP - 449
EP - 452
JO - Blood
JF - Blood
IS - 6
ER -