title: Similar outcomes using myeloablative vs reduced-intensity allogeneic transplant preparative regimens for AML or MDS.
abstract: Although reduced-intensity conditioning (RIC) and non-myeloablative (NMA)-conditioning regimens have been used for over a decade, their relative efficacy vs myeloablative (MA) approaches to allogeneic hematopoietic cell transplantation in patients with AML and myelodysplasia (MDS) is unknown. We compared disease status, donor, graft and recipient characteristics with outcomes of 3731 MA with 1448 RIC/NMA procedures performed at 217 centers between 1997 and 2004. The 5-year univariate probabilities and multivariate relative risk outcomes of relapse, TRM, disease-free survival (DFS) and OS are reported. Adjusted OS at 5 years was 34, 33 and 26% for MA, RIC and NMA transplants, respectively. NMA conditioning resulted in inferior DFS and OS, but there was no difference in DFS and OS between RIC and MA regimens. Late TRM negates early decreases in toxicity with RIC and NMA regimens. Our data suggest that higher regimen intensity may contribute to optimal survival in patients with AML/MDS, suggesting roles for both regimen intensity and graft vs leukemia in these diseases. Prospective studies comparing regimens are needed to confirm this finding and determine the optimal approach to patients who are eligible for either MA or RIC/NMA conditioning.
authors: Abramson Cancer Center, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
authors: S M
authors: SM
authors: Luger
authors: O
authors: O
authors: Ringdén
authors: M-J
authors: MJ
authors: Zhang
authors: W S
authors: WS
authors: Pérez
authors: M R
authors: MR
authors: Bishop
authors: M
authors: M
authors: Bornhauser
authors: C N
authors: CN
authors: Bredeson
authors: M S
authors: MS
authors: Cairo
authors: E A
authors: EA
authors: Copelan
authors: R P
authors: RP
authors: Gale
authors: S A
authors: SA
authors: Giralt
authors: Z
authors: Z
authors: Gulbas
authors: V
authors: V
authors: Gupta
authors: G A
authors: GA
authors: Hale
authors: H M
authors: HM
authors: Lazarus
authors: V A
authors: VA
authors: Lewis
authors: M C
authors: MC
authors: Lill
authors: P L
authors: PL
authors: McCarthy
authors: D J
authors: DJ
authors: Weisdorf
authors: M A
authors: MA
authors: Pulsipher
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D018572:Disease-Free Survival; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000601:surgery / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000601:surgery / Q000628:therapy*; D019172:Transplantation Conditioning / Q000379:methods*; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult