Influence of conditioning regimen intensity on outcomes post‐allogeneic hematopoietic cell transplantation for acute myeloid leukemia in complete morphological remission

Abstract

IntroductionThe literature comparing outcomes between myeloablative (MAC) and reduced intensity conditioning (RIC) for acute myeloid leukemia (AML) is conflicting.MethodsWe retrospectively analyzed 451 patients who underwent allogenic hematopoietic cell transplantation (alloHCT) for AML in complete remission (CR) with either RIC (n = 331) or MAC (n = 120) with the use of dual T‐cell depletion as graft‐versus‐host disease (GVHD) prophylaxis.ResultsUnivariate analysis demonstrated nonrelapse mortality (NRM) at 2 years was 19.1% for MAC and 22.5% for RIC (p = .44). Two‐year cumulative incidence of relapse (CIR) was 19.8% for MAC and 24.5% for RIC (p = .15). Two‐year overall survival (OS) was 61% and 53% for MAC and RIC, respectively (p = .02). Two‐year graft‐versus‐host disease relapse‐free survival (GRFS) was 40.8% for MAC and 33.7% for RIC (p = .30).A propensity score‐matched analysis was done matching patients for age, HLA match, in vivo T‐cell depletion, and Disease Risk Index (DRI). Two‐year OS was 67% for MAC, 66% for RIC (p = .95). A subgroup analysis identified that matched related donor transplants benefit from MAC with OS at 2 years 82.6% versus 57.3% for RIC (p = .006).ConclusionsIn the matched‐related donor setting, MAC regimens may offer superior survival. Overall, for our cohort of predominantly in vivo T‐cell depleted patients the outcomes of MAC and RIC were similar.

Dual T Cell Depletion for Graft versus Host Disease Prevention in Peripheral Blood Haploidentical Hematopoietic Cell Transplantation for Adults with Hematological Malignancies

“…The major nding of our study is the feasibility and safety of performing haploHCT with PBSC and dual T cell resulting in acceptable OS, NRM and RFS. We did not nd a difference in outcomes between recipients of MAC and RIC, this nding has been recently reported by our group (25). Older age and high risk DRI remain predictors of worse OS and NRM.…”