title: Comparison between reduced intensity and conventional myeloablative allogeneic stem-cell transplantation in patients with hematologic malignancies aged between 50 and 59 years.
abstract: To evaluate the efficacy of reduced-intensity stem-cell transplantation (RIST), we retrospectively compared outcomes of 207 consecutive Japanese patients aged between 50 and 59 years with hematologic malignancies who received RIST (n=70) and conventional stem-cell transplantation (CST) (n=137). CST recipients received total body irradiation (TBI)-based or busulfan/cyclophosphamide-based regimens. RIST regimens were purine analog-based (n=67), 2 Gy TBI-based (n=2), and others (n=1). Most CST recipients (129/137) received calcineurin inhibitors and methotrexate as graft-versus-host (GVHD) prophylaxis, while 32 RIST recipients received cyclosporin. In all, 23 CST and five RIST recipients died without disease progression within 100 days of transplant. Grade II to IV acute GVHD occurred in 56 CST and 38 RIST recipients. There was no significant difference in overall survival (OS) and progression-free survival between CST and RIST. On multivariate analysis on OS, five variables were significant: preparative regimens (CST vs RIST) (hazard ratio=1.92, 95% confidence interval, 1.25-2.97; P=0.003), performance status (2-4 vs 0-1) (2.50, 1.51-4.16; P<0.001), risk of underlying diseases (1.85, 1.21-2.83; P=0.004), acute GVHD (2.57, 1.72-3.84; P<0.001), and CML (0.38, 0.21-0.69; P=0.002). We should be careful in interpreting results of this small-sized retrospective study; however, reduced regimen-related toxicity might contribute to better survival in RIST. The low relapse rates following RIST suggest a strong antitumor activity through allogeneic immunity.
authors.affiliation: Hematopoietic Stem Cell Transplantation Unit, the National Cancer Center Hospital, and Department of Cell Therapy & Transplantation Medicine, University of Tokyo, Japan.
authors.forename: R
authors.initials: R
authors.lastname: Kojima
authors.forename: M
authors.initials: M
authors.lastname: Kami
authors.forename: Y
authors.initials: Y
authors.lastname: Kanda
authors.forename: E
authors.initials: E
authors.lastname: Kusumi
authors.forename: Y
authors.initials: Y
authors.lastname: Kishi
authors.forename: Y
authors.initials: Y
authors.lastname: Tanaka
authors.forename: S
authors.initials: S
authors.lastname: Yoshioka
authors.forename: S
authors.initials: S
authors.lastname: Morishima
authors.forename: S
authors.initials: S
authors.lastname: Fujisawa
authors.forename: S-i
authors.initials: SI
authors.lastname: Mori
authors.forename: M
authors.initials: M
authors.lastname: Kasai
authors.forename: K
authors.initials: K
authors.lastname: Hatanaka
authors.forename: K
authors.initials: K
authors.lastname: Tajima
authors.forename: M
authors.initials: M
authors.lastname: Kasai
authors.forename: K
authors.initials: K
authors.lastname: Mitani
authors.forename: T
authors.initials: T
authors.lastname: Ichinohe
authors.forename: H
authors.initials: H
authors.lastname: Hirai
authors.forename: S
authors.initials: S
authors.lastname: Taniguchi
authors.forename: H
authors.initials: H
authors.lastname: Sakamaki
authors.forename: M
authors.initials: M
authors.lastname: Harada
authors.forename: Y
authors.initials: Y
authors.lastname: Takaue
mesh_terms: D005260:Female; D006086:Graft vs Host Disease / Q000453:epidemiology; D019337:Hematologic Neoplasms / Q000628:therapy*; D006801:Humans; D007938:Leukemia / Q000628:therapy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009190:Myelodysplastic Syndromes / Q000628:therapy; D012008:Recurrence; D033581:Stem Cell Transplantation / Q000009:adverse effects; D014184:Transplantation, Homologous / Q000009:adverse effects / Q000276:immunology / Q000379:methods