Reduced-toxicity conditioning prior to allogeneic stem cell transplantation improves outcome in patients with myeloid malignancies - Archive ouverte HAL Access content directly
Journal Articles Haematologica Year : 2014

Reduced-toxicity conditioning prior to allogeneic stem cell transplantation improves outcome in patients with myeloid malignancies

(1, 2) , (3) , (1) , (3) , (1) , (3) , (1, 4) , (1) , (1) , (5, 1, 2) , (1, 2, 5) , (1) , (1, 2, 5) , (6, 7, 8, 9, 3, 10) , (1, 2, 5)
1
2
3
4
5
6
7
8
9
10
Jean El Cheikh

Abstract

The introduction of reduced intensity/toxicity conditioning regimens has allowed allogeneic hematopoietic cell transplantation to be performed in patients who were previously considered too old or otherwise unfit. Although it led to a reduction in non-relapse mortality, disease control remains a major challenge. We studied the outcome of 165 patients with acute myeloid leukemia (n=124) or myelodysplastic syndrome (n=41) transplanted after conditioning with fludarabine (30 mg/m2/day for 5 days), intravenous busulfan (either 260 mg/m2: reduced intensity conditioning, or 390–520 mg/m2: reduced toxicity conditioning), and rabbit anti-thymoglobulin (2.5 mg/kg/day for 2 days). The median age of the patients at transplantation was 56.8 years. The 2-year relapse incidence was 29% (23% versus 39% for patients transplanted in first complete remission and those transplanted beyond first complete remission, respectively; P=0.008). The 2-year progression-free survival rate was 57% (95% CI: 49.9–65). It was higher in the groups with favorable or intermediate cytogenetics than in the group with unfavorable cytogenetics (72.7%, 60.5%, and 45.7%, respectively; P=0.03). The cumulative incidence of grades 2–4 and 3–4 acute graft-versus-host disease at day 100 was 19.3% and 7.9%, respectively. The cumulative incidence of chronic graft-versus-host disease at 1 year was 21.6% (severe forms: 7.8%). Non-relapse mortality at 1 year reached 11%. The 2-year overall survival rate was 61.8% (95% CI: 54.8–69.7). Unfavorable karyotype and disease status beyond first complete remission were associated with a poorer survival. This well-tolerated conditioning platform can lead to long-term disease control and offers possibilities of modulation according to disease stage or further development.
Fichier principal
Vignette du fichier
1762.full.pdf (271.7 Ko) Télécharger le fichier
Origin : Publication funded by an institution
Loading...

Dates and versions

hal-01325488 , version 1 (02-06-2016)

Licence

Attribution - CC BY 4.0

Identifiers

Cite

Claire Oudin, Patrice Chevallier, Sabine Furst, Thierry Guillaume, Jean El Cheikh, et al.. Reduced-toxicity conditioning prior to allogeneic stem cell transplantation improves outcome in patients with myeloid malignancies. Haematologica, 2014, 99 (11), pp.1762-1768. ⟨10.3324/haematol.2014.105981⟩. ⟨hal-01325488⟩
183 View
170 Download

Altmetric

Share

Gmail Facebook Twitter LinkedIn More