title: Conditioning intensity in middle-aged patients with AML in first CR: no advantage for myeloablative regimens irrespective of the risk group-an observational analysis by the Acute Leukemia Working Party of the EBMT.
abstract: In recipients of allogeneic hematopoietic stem cell transplantation with AML in CR1, reduced intensity (RIC) conditioning regimens are usually given to older patients and myeloablative regimens (MAC) to younger patients. We analyzed whether in middle-aged patients aged 40-60 years, MAC was superior to RIC in cytogenetically higher risk AML. Among 2974 patients, 1638 had MAC and 1336 RIC transplants. Cytogenetics were high risk in 508, intermediate risk in 2297 and low risk in 169. Overall survival (OS) was higher in patients with RIC with low-risk cytogenetics but not in the intermediate- or poor-risk AML. Relapse incidence was lower with MAC in poor- and intermediate-risk AML. Nonrelapse mortality (NRM) was higher in MAC in all cytogenetic risk groups. Multivariate analysis confirmed a significant leukemia-free survival and OS advantage for RIC in low risk but no advantage of MAC in intermediate- and poor-risk leukemia. In patients aged 40-60 years, MAC has no advantage over RIC. We confirm lower relapse but higher NRM risks with MAC. MAC is not superior in patients with higher risk cytogenetics, but is inferior to RIC in the small cohort of AML patients with low-risk cytogenetics.
authors.affiliation: Division of Hematology, University Hospital Basel, Basel, Switzerland.
authors.forename: J R
authors.initials: JR
authors.lastname: Passweg
authors.affiliation: EBMT Paris Study Office, Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Labopin
authors.affiliation: Erasmus MC-Daniel den Hoed Cancer Centre, Rotterdam, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Cornelissen
authors.affiliation: Stem Cell Transplantation Unit, Comprehensive Cancer Center, Helsinki University Hospital, Helsinki, Finland.
authors.forename: L
authors.initials: L
authors.lastname: Volin
authors.affiliation: Division of Hematology, Hospital St Louis & University Paris, Paris, France.
authors.forename: G
authors.initials: G
authors.lastname: Socié
authors.affiliation: CHU Department Hematologie, Hopital de Purpan, Toulouse, France.
authors.forename: A
authors.initials: A
authors.lastname: Huynh
authors.affiliation: CHU Bordeaux, Hôpital Haut-leveque, Pessac, France.
authors.forename: R
authors.initials: R
authors.lastname: Tabrizi
authors.affiliation: Department of Hematology, First Affiliated Hospital of Soochow University, Suzhou, China.
authors.forename: D
authors.initials: D
authors.lastname: Wu
authors.affiliation: Centre for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, UK.
authors.forename: C
authors.initials: C
authors.lastname: Craddock
authors.affiliation: Department of Hematology, Nijmegen Medical Centre, Radboud University, Nijmegen, The Netherlands.
authors.forename: N
authors.initials: N
authors.lastname: Schaap
authors.affiliation: Department of Hematology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Kuball
authors.affiliation: Department D'Hematologie, CHU Nantes, Nantes, France.
authors.forename: P
authors.initials: P
authors.lastname: Chevallier
authors.affiliation: Clinique Universitaire d'Hématologie CHU Grenoble, Grenoble, France.
authors.forename: J Y
authors.initials: JY
authors.lastname: Cahn
authors.affiliation: Département D'Onco-Hématologie, Institut Paoli Calmettes, Marseille, France.
authors.forename: D
authors.initials: D
authors.lastname: Blaise
authors.affiliation: Hematology-Oncology and BMT Research, Shariati Hospital, Teheran, Iran.
authors.forename: A
authors.initials: A
authors.lastname: Ghavamzadeh
authors.affiliation: CHU Hautepierre-Service d'Onco Hematologie, Strasbourg, France.
authors.forename: K
authors.initials: K
authors.lastname: Bilger
authors.affiliation: Ospedale San Raffaele, Milano, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Ciceri
authors.affiliation: Medizinische Klinik II, Klinikum Augsburg, Augsburg, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Schmid
authors.affiliation: Department of Bone Marrow Transplantation and Hematology-Oncology, Maria Sklodowska-Curie Memorial Cancer Center, Gliwice, Poland.
authors.forename: S
authors.initials: S
authors.lastname: Giebel
authors.affiliation: Hematology Division, Chaim Sheba Medical Center, Tel-Hashomer, Israel.
authors.forename: A
authors.initials: A
authors.lastname: Nagler
authors.affiliation: Department of Hematology, Hospital Saint Antoine, Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Mohty
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D064591:Allografts; D018572:Disease-Free Survival; D018380:Hematopoietic Stem Cell Transplantation; D015470:Leukemia, Myeloid, Acute / Q000401:mortality / Q000628:therapy; D012307:Risk Factors; D015996:Survival Rate; D019172:Transplantation Conditioning / Q000379:methods