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Influence of conditioning regimen intensity on outcomes post‐allogeneic hematopoietic cell transplantation for acute myeloid leukemia in complete morphological remission

2023; Wiley; Volume: 111; Issue: 4 Linguagem: Inglês

10.1111/ejh.14041

1600-0609

Tommy Alfaro Moya, Jonas Mattsson, Mats Remberger, Jeffrey H. Lipton, Dennis Dong Hwan Kim, Auro Viswabandya, Rajat Kumar, Wilson Lam, Arjun Law, Armin Gerbitz, Ivan Pašić, Igor Novitzky‐Basso, Fotios V. Michelis,

Immune Cell Function and Interaction

Abstract Introduction The literature comparing outcomes between myeloablative (MAC) and reduced intensity conditioning (RIC) for acute myeloid leukemia (AML) is conflicting. Methods We retrospectively analyzed 451 patients who underwent allogenic hematopoietic cell transplantation (alloHCT) for AML in complete remission (CR) with either RIC ( n = 331) or MAC ( n = 120) with the use of dual T‐cell depletion as graft‐versus‐host disease (GVHD) prophylaxis. Results Univariate analysis demonstrated nonrelapse mortality (NRM) at 2 years was 19.1% for MAC and 22.5% for RIC ( p = .44). Two‐year cumulative incidence of relapse (CIR) was 19.8% for MAC and 24.5% for RIC ( p = .15). Two‐year overall survival (OS) was 61% and 53% for MAC and RIC, respectively ( p = .02). Two‐year graft‐versus‐host disease relapse‐free survival (GRFS) was 40.8% for MAC and 33.7% for RIC ( p = .30). A propensity score‐matched analysis was done matching patients for age, HLA match, in vivo T‐cell depletion, and Disease Risk Index (DRI). Two‐year OS was 67% for MAC, 66% for RIC ( p = .95). A subgroup analysis identified that matched related donor transplants benefit from MAC with OS at 2 years 82.6% versus 57.3% for RIC ( p = .006). Conclusions In the matched‐related donor setting, MAC regimens may offer superior survival. Overall, for our cohort of predominantly in vivo T‐cell depleted patients the outcomes of MAC and RIC were similar.