title: Reduced intensity conditioning compared with myeloablative conditioning using unrelated donor transplants in patients with acute myeloid leukemia.
abstract: OBJECTIVE
  Reduced intensity conditioning regimen (RIC) is increasingly used in hematopoietic stem cell transplantation (HSCT). Unrelated donor (UD) transplants have more complications. We wanted to examine if RIC is a valid treatment option using UD in acute myeloblastic leukemia (AML).
  
  
  METHODS
  Between 1999 and 2005, 401 patients with AML were treated with RIC and 1,154 received myeloablative conditioning (MAC), using UD and reported to the European Group for Blood and Marrow Transplantation Registry. Patients < and > or = 50 years of age were analyzed separately.
  
  
  RESULTS
  Patients receiving RIC were older, received transplants more recently, received peripheral blood stem cells more frequently, and were treated with total-body irradiation less often. In multivariable analysis, in patients younger than 50 years of age, nonrelapse mortality (NRM) was similar using RIC (hazard ratio [HR], 0.85; P = .41), relapse was increased (HR, 1.46; P = .02) and leukemia-free survival (LFS) was the same (HR, 0.88; P = .28), as compared with MAC. In patients > or = 50 years of age, NRM was decreased in the RIC group (HR, 0.64; P = .04), relapse probability was not significantly different (HR, 1.34; P = .16) and LFS was similar (HR, 1.04; P = .79) compared with MAC. CONCLUSION RIC-UD transplants are associated with higher relapse in AML patients younger than 50 years of age and decreased NRM in those > or = 50 years compared with MAC-UD. LFS was similar after both conditioning regimens, regardless of age. Therefore, RIC-UD extend the use of allotransplants for elderly patients and strategies that decrease relapse should be considered mainly in younger patients with AML.
authors: Karolinska University Hospital, Centre for Allogeneic Stem Cell Transplantation, SE-141 86 Stockholm, Sweden. olle.ringden@labmed.ki.se
authors: Olle
authors: O
authors: Ringdén
authors: Myriam
authors: M
authors: Labopin
authors: Gerhard
authors: G
authors: Ehninger
authors: Dietger
authors: D
authors: Niederwieser
authors: Richard
authors: R
authors: Olsson
authors: Nadezda
authors: N
authors: Basara
authors: Juergen
authors: J
authors: Finke
authors: Rainer
authors: R
authors: Schwerdtfeger
authors: Matthias
authors: M
authors: Eder
authors: Donald
authors: D
authors: Bunjes
authors: Norbert-Claude
authors: NC
authors: Gorin
authors: Mohamad
authors: M
authors: Mohty
authors: Vanderson
authors: V
authors: Rocha
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000276:immunology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D014019:Tissue Donors; D019172:Transplantation Conditioning / Q000379:methods*; D055815:Young Adult