title: Equivalent outcomes using reduced intensity or conventional myeloablative conditioning transplantation for patients aged 35 years and over with AML.
abstract: Allogeneic hematopoietic stem cell transplantation provides the best chance of long-term survival for patients with AML, but is associated with an unpredictable risk of treatment-related mortality. From January 2000 to December 2010, we compared the outcomes for patients with AML aged 35 and over using reduced-intensity conditioning (RIC, N=60) or conventional myeloablative conditioning (MAC) regimen (N=72) transplantation. The median follow-up was 47 months (10-134). The 4-year cumulative incidence of non-relapse mortality was 21%. After adjusting for cytogenetic risk, gender donor/recipient mismatch and CD34+ cells, non-relapse mortality was significantly lower with the RIC regimen (P=0.027). The 4-year cumulative incidence of relapse was 38% and no difference was observed in the adjusted relapse rate between the two groups. The 4-year OS rate was 46%. Using both Cox regression and inverse probability-of-treatment weighted (IPTW) method, a similar OS rate was found with both regimens (adjusted hazard ratios for conventional vs reduced of 1.14 (95% CI 0.67-1.93, P=0.64) with Cox regression, and 1.14 (95% CI 0.55-2.34, P=0.73) with IPTW). Until prospective trials are completed, this study supports the use of a reduced-intensity regimen prior to transplantation for patients with AML aged 35 and over.
authors.affiliation: 1] Service d'Hématologie Sénior, Hôpital Saint Louis, Paris, France [2] Service d'Hématologie Greffe, Hôpital Saint Louis, Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Sébert
authors.affiliation: Département de Biostatistiques et d'Informatique Médicale, Hôpital Saint Louis, Paris, France.
authors.forename: R
authors.initials: R
authors.lastname: Porcher
authors.affiliation: Service d'Hématologie Greffe, Hôpital Saint Louis, Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Robin
authors.affiliation: 1] Service d'Hématologie Sénior, Hôpital Saint Louis, Paris, France [2] Service d'Hématologie Clinique, Hôpital Avicenne, Bobigny, France.
authors.forename: L
authors.initials: L
authors.lastname: Adès
authors.affiliation: Service d'Hématologie Clinique, Hôpital Saint Louis, Paris, France.
authors.forename: N
authors.initials: N
authors.lastname: Boissel
authors.affiliation: Service d'Hématologie Clinique, Hôpital Saint Louis, Paris, France.
authors.forename: E
authors.initials: E
authors.lastname: Raffoux
authors.affiliation: Service d'Hématologie Greffe, Hôpital Saint Louis, Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Xhaard
authors.affiliation: Service d'Hématologie Greffe, Hôpital Saint Louis, Paris, France.
authors.forename: N
authors.initials: N
authors.lastname: Dhedin
authors.affiliation: 1] AP-HP, Hôpital Saintl-Louis, Unité de Thérapie Cellulaire et CIC de biothérapies, Paris, France [2] Université Paris Diderot, Paris, France.
authors.forename: J
authors.initials: J
authors.lastname: Larghero
authors.affiliation: Service d'Hématologie Clinique, Reims, France.
authors.forename: C
authors.initials: C
authors.lastname: Himberlin
authors.affiliation: Service d'Hématologie Clinique, Reims, France.
authors.forename: A
authors.initials: A
authors.lastname: Delmer
authors.affiliation: 1] Service d'Hématologie Sénior, Hôpital Saint Louis, Paris, France [2] Service d'Hématologie Clinique, Hôpital Avicenne, Bobigny, France.
authors.forename: P
authors.initials: P
authors.lastname: Fenaux
authors.affiliation: Service d'Hématologie Clinique, Hôpital Saint Louis, Paris, France.
authors.forename: H
authors.initials: H
authors.lastname: Dombret
authors.affiliation: Service d'Hématologie Greffe, Hôpital Saint Louis, Paris, France.
authors.forename: G
authors.initials: G
authors.lastname: Socié
authors.affiliation: Service d'Hématologie Greffe, Hôpital Saint Louis, Paris, France.
authors.forename: R P
authors.initials: RP
authors.lastname: de Latour
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D064591:Allografts; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012737:Sex Factors; D015996:Survival Rate; D019172:Transplantation Conditioning