TY - JOUR
T1 - Allogeneic hematopoietic stem-cell transplantation in AML and MDS using myeloablative versus reduced-intensity conditioning
T2 - The role of dose intensity
AU - Shimoni, A.
AU - Hardan, I.
AU - Shem-Tov, N.
AU - Yeshurun, M.
AU - Yerushalmi, R.
AU - Avigdor, A.
AU - Ben-Bassat, I.
AU - Nagler, A.
PY - 2006/2
Y1 - 2006/2
N2 - Allogeneic stem-cell transplantation (SCT) with both myeloablative and reduced-intensity conditioning (RIC) is an effective therapy in AML/MDS. However, the relative merits of each may differ in different settings. To define the role of dose intensity, we analyzed SCT outcomes of 112 consecutive patients with AML/MDS. A total of 45 patients met eligibility criteria for standard myeloablative conditioning and were given intravenous-busulfan (12.8mg/kg) and cyclophosphamide (ivBuCy). A total of 67 noneligible patients were given RIC with fludarabine and intravenous-busulfan (6.4mg/kg, FB2, n =41) or a modified myeloablative regimen with fludarabine and myeloablative doses of intravenous-busulfan (12.8mg/kg, FB4, n =26). The overall survival (OS) at 2 years was 50, 49 and 47% after ivBuCy, FB4 and FB2, respectively (P =NS). Nonrelapse mortality was higher after ivBuCy, 22 vs 8% (P =0.05), but relapse rates were lower. Active disease at SCT was the most significant predictor of reduced survival in multivariable analysis (HR 4.5, P =0.0001). Myeloablative and RIC regimens had similar outcomes when leukemia was in remission at SCT; however, patients with active disease could only be salvaged by myeloablative conditioning. Among the latter, OS was 45% after ivBuCy but no FB2 recipient survived (P =0.02). Patients with active disease, ineligible for standard myeloablation, could tolerate modified myeloablation well; however, long-term outcome cannot be determined yet.
AB - Allogeneic stem-cell transplantation (SCT) with both myeloablative and reduced-intensity conditioning (RIC) is an effective therapy in AML/MDS. However, the relative merits of each may differ in different settings. To define the role of dose intensity, we analyzed SCT outcomes of 112 consecutive patients with AML/MDS. A total of 45 patients met eligibility criteria for standard myeloablative conditioning and were given intravenous-busulfan (12.8mg/kg) and cyclophosphamide (ivBuCy). A total of 67 noneligible patients were given RIC with fludarabine and intravenous-busulfan (6.4mg/kg, FB2, n =41) or a modified myeloablative regimen with fludarabine and myeloablative doses of intravenous-busulfan (12.8mg/kg, FB4, n =26). The overall survival (OS) at 2 years was 50, 49 and 47% after ivBuCy, FB4 and FB2, respectively (P =NS). Nonrelapse mortality was higher after ivBuCy, 22 vs 8% (P =0.05), but relapse rates were lower. Active disease at SCT was the most significant predictor of reduced survival in multivariable analysis (HR 4.5, P =0.0001). Myeloablative and RIC regimens had similar outcomes when leukemia was in remission at SCT; however, patients with active disease could only be salvaged by myeloablative conditioning. Among the latter, OS was 45% after ivBuCy but no FB2 recipient survived (P =0.02). Patients with active disease, ineligible for standard myeloablation, could tolerate modified myeloablation well; however, long-term outcome cannot be determined yet.
KW - Acute myeloid
KW - Intravenous busulfan
KW - Reduced-intensity conditioning
KW - Stem-cell transplantation
UR - http://www.scopus.com/inward/record.url?scp=31444444950&partnerID=8YFLogxK
U2 - 10.1038/sj.leu.2404037
DO - 10.1038/sj.leu.2404037
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AN - SCOPUS:31444444950
SN - 0887-6924
VL - 20
SP - 322
EP - 328
JO - Leukemia
JF - Leukemia
IS - 2
ER -