title: Case-matched comparison with standard versus reduced intensity conditioning regimen in chronic myeloid leukemia patients.
abstract: This retrospective case-matched study evaluated the efficacy of reduced intensity conditioning (RIC) regimen on early and late allogeneic transplant outcome in chronic myeloid leukemia (CML) patients. Twenty-eight patients conditioned with RIC regimen were matched to 56 patients who received a myeloablative conditioning (MAC) regimen. The main criteria for case matching among our CML allotransplant cohort were the Gratwohl scoring system. The median score was 2 (1-4) in each group. The pretransplant disease status was first chronic phase (CP1, n = 20), CP2 (n = 2), and advanced phase (n = 6) in RIC, and CP1 (n = 46), CP2 (n = 3), and advanced phase (n = 7) in MAC. The duration of neutropenia and thrombocytopenia was shorter in RIC than MAC. The grade and duration of mucositis were less in RIC. The need for total parenteral nutrition (21% vs. 77%, p < 0.0001) and febrile neutropenic episodes (50% vs. 95%, p < 0.0001) were observed less frequently in RIC compared with MAC-given patients. Acute or chronic graft versus host diseases (GvHD) were not affected by the intensity of conditioning regimen. The incidence of transplant-related mortality was higher in MAC (7% vs. 14%, p = 0.01). Although more relapse/progression was observed in the RIC group, the probability of 5- and 10-year leukemia-free- and overall survival were similar regardless of conditioning regimen intensity (p > 0.05). In early first CP, the pair of female donor-male recipient and the development of chronic GvHD prolonged both leukemia-free survival and overall survival in multivariate analysis. According to our single-center matched-pair analysis, the use of RIC regimens in patients with low-risk CML results with toxicities less, responses later, and relapses more frequent than the MAC regimens.
authors.affiliation: Stem Cell Transplantation Unit, Department of Hematology, Faculty of Medicine, Ankara University, Cebeci Campus, 06590 Ankara, Turkey. topcuogl@medicine.ankara.edu.tr
authors.forename: Pervin
authors.initials: P
authors.lastname: Topcuoglu
authors.forename: Mutlu
authors.initials: M
authors.lastname: Arat
authors.forename: Muhit
authors.initials: M
authors.lastname: Ozcan
authors.forename: Onder
authors.initials: O
authors.lastname: Arslan
authors.forename: Osman
authors.initials: O
authors.lastname: Ilhan
authors.forename: Meral
authors.initials: M
authors.lastname: Beksac
authors.forename: Gunhan
authors.initials: G
authors.lastname: Gurman
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D006086:Graft vs Host Disease / Q000517:prevention & control; D006801:Humans; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D033581:Stem Cell Transplantation / Q000379:methods*; D015996:Survival Rate; D019172:Transplantation Conditioning / Q000379:methods*; D014184:Transplantation, Homologous / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult