Long-term survival and late events after allogeneic stem cell transplantation from HLA-matched siblings for acute myeloid leukemia with myeloablative compared to reduced-intensity conditioning: a report on behalf of the acute leukemia working party of European group for blood and marrow transplantation.
Myeloablative (MAC) and reduced-intensity conditioning (RIC) are established approaches for allogeneic stem cell transplantation (SCT) in acute myeloid leukemia (AML). Most deaths after MAC occur within the first 2 years after SCT, while patients surviving leukemia-free for 2 years can expect a favorable long-term outcome. However, there is paucity of data on the long-term outcome (beyond 10 years) and the pattern of late events following RIC due to the relative recent introduction of this approach.



We analyzed long-term outcomes in a cohort of 1423 AML patients, age ≥50 years, after SCT from HLA-matched siblings, during the years 1997-2005, median follow-up 8.3 years (0.1-17).



The 10-year leukemia-free survival (LFS) was 31 % (95CI, 27-35) and 32 % (28-35) after MAC and RIC, respectively (P = 0.57). The 10-year GVHD/ relapse-free survival (GRFS), a surrogate for quality of life was 22 % (18-25) and 21 % (18-24), respectively (P = 0.79). The 10-year non-relapse mortality (NRM) was higher and relapse rate was lower after MAC, throughout the early and late post-transplant course. The 10-year LFS among 584 patients surviving leukemia-free 2 years after SCT was 71 % (65-76) and 73 % (67-78) after MAC and RIC, respectively (P = 0.76). Advanced leukemia at SCT was the major predictor of LFS subsequent to the 2-year landmark. Relapse was the major cause of late death after both regimens; however, NRM and in particular chronic graft-versus-host disease and second cancers were more common causes of late death after MAC.



Long-term LFS and GRFS are similar after RIC and MAC. Most events after RIC or MAC occur within the first 2 years after SCT. Patients who are leukemia-free 2 years after SCT can expect similar good subsequent outcome after both approaches.
Department of Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel HaShomer and Tel-Aviv University, Tel Aviv, Israel. ashimoni@sheba.health.gov.il.
Avichai
A
Shimoni
Hôpital Saint Antoine, ALWP office, Service d'Hématologie et de Thérapie cellulaire, Paris, France.
Myriam
M
Labopin
Vanderbilt University Hematology and Transplantation, Nashville, USA.
Bipin
B
Savani
Stem Cell Transplantation Unit, HUCH Comprehensive Cancer Center, Helsinki, Finland.
Liisa
L
Volin
Universitaetsklinikum Dresden, Medizinische Klinik und Poliklinik I, Dresden, Germany.
Gerhard
G
Ehninger
Department of Haematology, University Medical Centre, Utrecht, The Netherlands.
Jurgen
J
Kuball
Klinik fuer Innere Medzin III, Universitätsklinikum Ulm, Ulm, Germany.
Donald
D
Bunjes
Department of Hematology, Nijmegen Medical Centre, Nijmegen, The Netherlands.
Nicolaas
N
Schaap
CHU Bordeaux, Hôpital Haut-leveque, Pessac, France.
Stephane
S
Vigouroux
Department of Haematology II, Ospedale San Martino, Genoa, Italy.
Andrea
A
Bacigalupo
Leiden University Hospital, BMT Centre Leiden, Leiden, The Netherlands.
Hendrik
H
Veelken
Hematology Department, IIB Sant Pau and Josep Carreras Leukemia Research Institutes, Hospital Santa Creu i Sant Pau, Barcelona, Spain.
Jorge
J
Sierra
Department of Haematology, Hemostasis, Oncology, and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany.
Matthias
M
Eder
University Hospital Leipzig, Division of Haematology and Oncology, Leipzig, Germany.
Dietger
D
Niederwieser
Hôpital Saint Antoine, ALWP office, Service d'Hématologie et de Thérapie cellulaire, Paris, France.
Mohamad
M
Mohty
Department of Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel HaShomer and Tel-Aviv University, Tel Aviv, Israel.|Hôpital Saint Antoine, ALWP office, Service d'Hématologie et de Thérapie cellulaire, Paris, France.
Arnon
A
Nagler
D000368:Aged; D001782:Blood Donors; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods* / Q000401:mortality / Q000592:standards; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000150:complications / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D019653:Myeloablative Agonists / Q000627:therapeutic use*; D012008:Recurrence; D012189:Retrospective Studies; D035781:Siblings; D019172:Transplantation Conditioning / Q000401:mortality* / Q000592:standards
D019653:Myeloablative Agonists
Acute myeloid leukemia; Allogeneic stem cell transplantation; Long-term outcome; Myeloablative conditioning; Reduced-intensity conditioning