title: Reduced-intensity vs myeloablative conditioning allogeneic hematopoietic SCT for patients aged over 45 years with ALL in remission: a study from the Adult ALL Working Group of the Japan Society for Hematopoietic Cell Transplantation (JSHCT).
abstract: In this study, outcomes for 575 adult ALL patients aged ≥45 years who underwent first allo-SCT in CR were analyzed according to the type of conditioning regimen (myeloablative conditioning (MAC) for 369 patients vs reduced-intensity conditioning (RIC) for 206 patients). Patients in the RIC group were older (median age, 58 vs 51 years, P<0.0001). There were no statistically significant differences in 3-year OS, disease-free survival (DFS) and non-relapse mortality (NRM): 51% vs 53%, 47% vs 39% and 38% vs 36%, respectively. Multivariate analysis showed that CR2 and HLA mismatching were associated with poor OS (P=0.002 and P=0.019, respectively). HLA mismatching was associated with lower rate of relapse (P=0.016), but was associated with higher rate of NRM (P=0.001). RIC was associated with good OS and DFS in patients who received HLA-mismatch transplantation and were aged ≥55 years compared with MAC by multivariate analysis for each event with interaction (hazard ratio (HR) and 95% confidence interval 0.35 and 0.15-0.81, P=0.014 for OS and 0.36 and 0.16-0.81, P=0.013 for DFS). Therefore, patients ≥55 years of age with HLA-mismatch transplantation should be candidates for RIC rather than MAC.
authors.affiliation: Department of Hematology and Oncology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: J
authors.initials: J
authors.lastname: Tanaka
authors.forename: H
authors.initials: H
authors.lastname: Kanamori
authors.forename: S
authors.initials: S
authors.lastname: Nishiwaki
authors.forename: K
authors.initials: K
authors.lastname: Ohashi
authors.forename: S
authors.initials: S
authors.lastname: Taniguchi
authors.forename: T
authors.initials: T
authors.lastname: Eto
authors.forename: H
authors.initials: H
authors.lastname: Nakamae
authors.forename: K
authors.initials: K
authors.lastname: Minagawa
authors.forename: K
authors.initials: K
authors.lastname: Miyamura
authors.forename: H
authors.initials: H
authors.lastname: Sakamaki
authors.forename: Y
authors.initials: Y
authors.lastname: Morishima
authors.forename: K
authors.initials: K
authors.lastname: Kato
authors.forename: R
authors.initials: R
authors.lastname: Suzuki
authors.forename: N
authors.initials: N
authors.lastname: Nishimoto
authors.forename: K
authors.initials: K
authors.lastname: Oba
authors.forename: N
authors.initials: N
authors.lastname: Masauzi
mesh_terms: D000368:Aged; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D012008:Recurrence; D012189:Retrospective Studies; D019172:Transplantation Conditioning / Q000379:methods*; D014184:Transplantation, Homologous