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

Abstract

<p id="d2678215e619"> <div class="list"> <a class="named-anchor" id="d2678215e621"> <!-- named anchor --> </a> <ul class="so-custom-list"> <li id="d2678215e622"> <div class="so-custom-list-content so-ol"> <p class="first" id="d2678215e623">RIC is a reasonable alternative to MAC for CML patients in the TKI era.</p> </div> </li> <li id="d2678215e625"> <div class="so-custom-list-content so-ol"> <p class="first" id="d2678215e626">In CML patients, RIC results in similar survival as MAC, albeit at the expense of increased early posttransplant relapse. </p> </div> </li> </ul> </div> </p><p class="first" id="d2678215e630">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; <i>P</i> = .001). The cumulative incidence of chronic graft-versus-host disease (cGVHD) was lower with RIC than with MAC (HR, 0.77; <i>P</i> = .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. </p><p id="d2678215e642"> <div class="fig panel" id="absf1"> <a class="named-anchor" id="absf1"> <!-- named anchor --> </a> <div class="figure-container so-text-align-c"> <img alt="" class="figure" src="/document_file/5a0a323f-c2b7-485b-b37d-38ce000d3c4f/PubMedCentral/image/advances024844absf1"/> </div> <div class="panel-content"/> </div> </p>