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Akahoshi Y, Tada Y, Sakaida E, Kusuda M, Doki N, Uchida N, Fukuda T, Tanaka M, Sawa M, Katayama Y, Matsuoka KI, Ozawa Y, Onizuka M, Kanda J, Kanda Y, Atsuta Y, Nakasone H. Novel risk assessment for the intensity of conditioning regimen in older patients. Blood Adv 2023; 7:4738-4747. [PMID: 36508283 PMCID: PMC10468368 DOI: 10.1182/bloodadvances.2022008706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/01/2022] [Accepted: 09/10/2022] [Indexed: 12/14/2022] Open
Abstract
Reduced-intensity conditioning (RIC) regimens have long-term outcomes that are generally comparable with those of myeloablative conditioning (MAC) because of a lower risk of nonrelapse mortality (NRM) but a higher risk of relapse. However, it is unclear how we should select the conditioning intensity in individual cases. We propose the risk assessment for the intensity of conditioning regimen in elderly patients (RICE) score. We retrospectively analyzed 6147 recipients aged 50 to 69 years using a Japanese registry database. Based on the interaction analyses, advanced age (≥60 years), hematopoietic cell transplantation-specific comorbidity index (≥2), and umbilical cord blood were used to design a scoring system to predict the difference in an individual patient's risk of NRM between MAC and RIC: the RICE score, which is the sum of the 3 factors. Zero or 1 implies low RICE score and 2 or 3, high RICE score. In multivariate analyses, RIC was significantly associated with a decreased risk of NRM in patients with a high RICE score (training cohort: hazard ratio [HR], 0.73; 95% confidence interval [CI], 0.60-0.90; P = .003; validation cohort: HR, 0.57; 95% CI, 0.43-0.77; P < .001). In contrast, we found no significant differences in NRM between MAC and RIC in patients with a low RICE score (training cohort: HR, 0.99; 95% CI, 0.85-1.15; P = .860; validation cohort: HR, 0.81; 95% CI, 0.66-1.01; P = .061). In summary, a new and simple scoring system, the RICE score, appears to be useful for personalizing the conditioning intensity and could improve transplant outcomes in older patients.
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Affiliation(s)
- Yu Akahoshi
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Yuma Tada
- Department of Hematology, Osaka International Cancer Institute, Osaka, Japan
| | - Emiko Sakaida
- Department of Hematology, Chiba University Hospital, Chiba, Japan
| | - Machiko Kusuda
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Noriko Doki
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Naoyuki Uchida
- Department of Hematology, Federation of National Public Service Personnel Mutual Aid Associations Toranomon Hospital, Tokyo, Japan
| | - Takahiro Fukuda
- Division of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - Masatsugu Tanaka
- Department of Hematology, Kanagawa Cancer Center, Kanagawa, Japan
| | - Masashi Sawa
- Department of Hematology and Oncology, Anjo Kosei Hospital, Aichi, Japan
| | - Yuta Katayama
- Department of Hematology, Hiroshima Red Cross Hospital and Atomic Bomb Survivors Hospital, Hiroshima, Japan
| | - Ken-ichi Matsuoka
- Department of Hematology and Oncology, Okayama University Hospital, Okayama, Japan
| | - Yukiyasu Ozawa
- Department of Hematology, Japanese Red Cross Nagoya First Hospital, Aichi, Japan
| | - Makoto Onizuka
- Department of Hematology and Oncology, Tokai University School of Medicine, Kanagawa, Japan
| | - Junya Kanda
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yoshinobu Kanda
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
- Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Yoshiko Atsuta
- Japanese Data Center for Hematopoietic Cell Transplantation, Aichi, Japan
- Department of Registry Science for Transplant and Cellular Therapy, Aichi Medical University School of Medicine, Aichi, Japan
| | - Hideki Nakasone
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
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Walter RB, Sandmaier BM, Othus M, Orvain C, Rodríguez-Arbolí E, Oshima MU, Schoch G, Davis C, Joachim Deeg H, Storb R. Comparison of reduced intensity and nonmyeloablative conditioning for adults with acute myeloid leukemia undergoing allogeneic hematopoietic cell transplantation in first or second remission. Bone Marrow Transplant 2023; 58:377-385. [PMID: 36577856 PMCID: PMC10170527 DOI: 10.1038/s41409-022-01909-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 12/19/2022] [Accepted: 12/21/2022] [Indexed: 12/29/2022]
Abstract
Reduced intensity conditioning (RIC) and nonmyeloablative (NMA) conditioning regimens have expanded use of allogeneic hematopoietic cell transplantation (HCT) in AML to include older and medically less-fit patients, but relative efficacies and toxicities remain poorly defined. Here, we analyzed outcomes from 343 adults transplanted in remission after RIC (n = 137) or NMA (n = 206) conditioning between 2006 and 2021. The characteristics of RIC and NMA HCT patients were similar except that RIC patients were younger and their time between most recent remission achievement and allografting was shorter. There were no significant differences in relapse risk, relapse-free survival (RFS), overall survival (OS), and non-relapse mortality (NRM) between RIC and NMA HCT patients, both overall (relapse: hazard ratio [HR] = 0.80, P = 0.27; RFS: HR = 0.93, P = 0.61; OS: HR = 0.93, P = 0.66; NRM: HR = 1.13, P = 0.59) and when patients were stratified by pre-HCT measurable residual disease (MRD) status. After multivariable adjustment, there was no statistically significant association between conditioning intensity and relapse (HR = 0.69, P = 0.088), RFS (HR = 0.86, P = 0.37), OS (HR = 0.89, P = 0.49), or NRM (HR = 1.37, P = 0.19). In this non-randomized cohort of adults undergoing allografting for AML in first or second remission at our center, we could not detect statistically significant differences in outcomes between those assigned to RIC and those assigned to NMA conditioning.
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Affiliation(s)
- Roland B Walter
- Fred Hutchinson Cancer Center, Seattle, WA, USA.
- Department of Medicine, Division of Hematology, University of Washington, Seattle, WA, USA.
- Department of Laboratory Medicine & Pathology, University of Washington, Seattle, WA, USA.
- Department of Epidemiology, University of Washington, Seattle, WA, USA.
| | - Brenda M Sandmaier
- Fred Hutchinson Cancer Center, Seattle, WA, USA
- Department of Medicine, Division of Medical Oncology, University of Washington, Seattle, WA, USA
| | - Megan Othus
- Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Corentin Orvain
- Fred Hutchinson Cancer Center, Seattle, WA, USA
- Department of Medicine, Division of Hematology, University of Washington, Seattle, WA, USA
| | | | - Masumi U Oshima
- Fred Hutchinson Cancer Center, Seattle, WA, USA
- Department of Medicine, Division of Medical Oncology, University of Washington, Seattle, WA, USA
| | - Gary Schoch
- Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Chris Davis
- Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - H Joachim Deeg
- Fred Hutchinson Cancer Center, Seattle, WA, USA
- Department of Medicine, Division of Medical Oncology, University of Washington, Seattle, WA, USA
| | - Rainer Storb
- Fred Hutchinson Cancer Center, Seattle, WA, USA
- Department of Medicine, Division of Medical Oncology, University of Washington, Seattle, WA, USA
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Yanada M, Harada K, Shimomura Y, Arai Y, Konuma T. Conditioning regimens for allogeneic hematopoietic cell transplantation in acute myeloid leukemia: Real-world data from the Japanese registry studies. Front Oncol 2022; 12:1050633. [PMID: 36505853 PMCID: PMC9732425 DOI: 10.3389/fonc.2022.1050633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 11/14/2022] [Indexed: 11/27/2022] Open
Abstract
Conditioning regimens play a crucial role in preventing relapse of acute myeloid leukemia (AML) following allogeneic hematopoietic cell transplantation (HCT). In early times, myeloablative conditioning was used exclusively, but it was associated with significant toxicity. However, the advent of reduced-intensity conditioning has allowed allogeneic HCT to be performed more safely, leading to an expansion of our choices for conditioning regimens. As the transplantation methods have become highly diversified, it is reasonable to determine an optimal conditioning regimen in consideration of patient-, disease-, and transplantation-related factors. In this context, large-scale registry-based studies provide real-world data to allow for a detailed evaluation of the utility of individual conditioning regimens in specific clinical settings. The Japanese Society for Transplantation and Cellular Therapy has been conducting a nationwide survey for HCT since 1993 that currently covers >99% of all the transplantation centers nationwide, and >1,000 allogeneic HCTs performed for adults with AML are registered per year. We have been using the registry data to implement a number of studies focusing on adults with AML, and the large number of patients registered consecutively from nearly all transplantation centers nationwide represent real-world practice in Japan. This article reviews and discusses the results obtained from our registry-based studies pertaining to various conditioning regimens.
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Affiliation(s)
- Masamitsu Yanada
- Department of Hematology and Cell Therapy, Aichi Cancer Center, Nagoya, Japan,*Correspondence: Masamitsu Yanada,
| | - Kaito Harada
- Department of Hematology and Oncology, Tokai University School of Medicine, Isehara, Japan
| | - Yoshimitsu Shimomura
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Yasuyuki Arai
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takaaki Konuma
- Department of Hematology/Oncology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
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Zhang D, Chen J. Efficacy of decitabine combined with allogeneic hematopoietic stem cell transplantation in the treatment of recurrent and refractory acute myeloid leukemia (AML): A systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e30644. [PMID: 36123842 PMCID: PMC9478241 DOI: 10.1097/md.0000000000030644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 08/18/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND This analysis aimed to assess the effect of decitabine combined with allogeneic hematopoietic stem cell transplantation (allo-HSCT) in treating recurrent and refractory acute myeloid leukemia. METHOD The present analysis was carried out according to the principles of Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline statement. Web of Science, Embase, PubMed, The Cochrane Library, CNKI, VIP, and WanFang Data databases were searched for trials published from their corresponding inception to September 13, 2021. Retrospective research or published randomized controlled trials in Chinese or English were ruled out. The methodological quality of the included studies was assessed using the Physiotherapy Evidence Database scale. Mean differences with 95% confidence intervals were used to analyze continuous data. The I2 test was used to determine heterogeneity, and the meta-analysis was conducted using Revman 5.4. RESULTS Eight studies including 795 participants in total were identified. Decitabine and allo-HSCT showed significant reductions in recurrence after transplantation (odds ratio [OR] = 0.29, 95% confidence interval [CI] (0.17, 0.50), P < .00001), leukemia-free survival (OR = 2.17, 95% CI (1.47, 3.21), P < .0001), graft related death (OR = 0.50, 95% CI (0.25, 0.98), P = .04), and significant improvements in complete remission (OR = 0.39, 95% CI = 0.23-0.68, P = .0007) and partial remission (OR = 0.46, 95%CI = 0.27-0.78, P = .004). The median follow-up time, acute graft-versus-host disease, and no remission had no significant difference between treatment and control groups (the median follow-up time: OR = -1.76, 95% CI (-6.28, 2.76), P = .45; acute graft-versus-host disease: OR = 0.72, 95% CI (0.50, 1.03), P = .08; no remission: OR = 3.19, 95%CI = 2.06-4.94, P = .05). Overall, the magnitude of the effect was found to be in the small to moderate range. CONCLUSION Decitabine combined with allo-HSCT can obtain lower recurrence risk and longer disease-free survival time, and improve the prognosis of patients. The safety is relatively stable. Due to the varying quality level of the included studies, the validation of multiple high-quality studies still needs improvement.
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Affiliation(s)
- Donghui Zhang
- Department of Pharmacy, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Jiahui Chen
- Department of Clinical Skills Training Center, Clinical Academic Affairs Office, The First Hospital of Lanzhou University, Lanzhou, China
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Establishment of a Predictive Model for GvHD-free, Relapse-free Survival after Allogeneic HSCT using Ensemble Learning. Blood Adv 2021; 6:2618-2627. [PMID: 34933327 PMCID: PMC9043925 DOI: 10.1182/bloodadvances.2021005800] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 11/23/2021] [Indexed: 12/03/2022] Open
Abstract
Stacked ensemble of machine-learning algorithms could establish more accurate prediction model for survival analysis than existing methods. Stacked ensemble model can be applied to personalized prediction of HSCT outcomes from pretransplant characteristics.
Graft-versus-host disease-free, relapse-free survival (GRFS) is a useful composite end point that measures survival without relapse or significant morbidity after allogeneic hematopoietic stem cell transplantation (allo-HSCT). We aimed to develop a novel analytical method that appropriately handles right-censored data and competing risks to understand the risk for GRFS and each component of GRFS. This study was a retrospective data-mining study on a cohort of 2207 adult patients who underwent their first allo-HSCT within the Kyoto Stem Cell Transplantation Group, a multi-institutional joint research group of 17 transplantation centers in Japan. The primary end point was GRFS. A stacked ensemble of Cox Proportional Hazard (Cox-PH) regression and 7 machine-learning algorithms was applied to develop a prediction model. The median age for the patients was 48 years. For GRFS, the stacked ensemble model achieved better predictive accuracy evaluated by C-index than other state-of-the-art competing risk models (ensemble model: 0.670; Cox-PH: 0.668; Random Survival Forest: 0.660; Dynamic DeepHit: 0.646). The probability of GRFS after 2 years was 30.54% for the high-risk group and 40.69% for the low-risk group (hazard ratio compared with the low-risk group: 2.127; 95% CI, 1.19-3.80). We developed a novel predictive model for survival analysis that showed superior risk stratification to existing methods using a stacked ensemble of multiple machine-learning algorithms.
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Austin AE, Byrne M. Detecting and preventing post-hematopoietic cell transplant relapse in AML. Curr Opin Hematol 2021; 28:380-388. [PMID: 34534984 DOI: 10.1097/moh.0000000000000686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Relapsed disease is the primary cause of mortality for acute myeloid leukemia (AML) patients after allogeneic hematopoietic cell transplantation (HCT). This review outlines the most recent advances in the detection and prevention of AML relapse following allogeneic HCT. RECENT FINDINGS Conventional methods for predicting post-HCT relapse rely on the molecular and cytogenetics features present at diagnosis. These methods are slow to reflect a growing understanding of the molecular heterogeneity of AML and impact of new therapies on post-HCT outcomes. The use of measurable residual disease (MRD) techniques, including multiparameter flow cytometry and molecular testing, may improve the prognostic ability of these models and should be incorporated into post-HCT surveillance whenever possible.In the post-HCT setting, FLT3 inhibitor maintenance data indicate that effective therapies can improve post-HCT outcomes. Maintenance data with DNA methyltransferase inhibitor monotherapy is less compelling and outcomes may improve with combinations. Early interventions directed at preemptive management of MRD may further improve post-HCT outcomes. SUMMARY Post-HCT AML relapse prevention has evolved to include more sensitive measures of disease detection and novel therapies that may improve outcomes of poor-risk AML patients. Additional work is needed to maintain this progress.
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Affiliation(s)
| | - Michael Byrne
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
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7
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Kunadt D, Stölzel F. Effective Immunosurveillance After Allogeneic Hematopoietic Stem Cell Transplantation in Acute Myeloid Leukemia. Cancer Manag Res 2021; 13:7411-7427. [PMID: 34594134 PMCID: PMC8478160 DOI: 10.2147/cmar.s261721] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 09/15/2021] [Indexed: 12/25/2022] Open
Abstract
The number of patients receiving allogeneic hematopoietic stem cell transplantation (alloHCT) has increased constantly over the last years due to advances in transplant technology development, supportive care, transplant safety, and donor availability. Currently, acute myeloid leukemia (AML) is the most frequent indication for alloHCT. However, disease relapse remains the main cause of therapy failure. Therefore, concepts of maintaining and, if necessary, reinforcing a strong graft-versus-leukemia (GvL) effect is crucial for the prognosis and long-term survival of the patients. Over the last decades, it has become evident that effective immunosurveillance after alloHCT is an entangled complex of donor-specific characteristics, leukemia-associated geno- and phenotypes, and acquired resistance mechanisms. Furthermore, adoption of effector cells such as natural killer (NK) cells, alloreactive and regulatory T-cells with their accompanying receptor repertoire, and cell–cell interactions driven by messenger molecules within the stem cell and the bone marrow niche have important impact. In this review of pre- and posttransplant elements and mechanisms of immunosurveillance, we highlight the most important mechanisms after alloHCT.
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Affiliation(s)
- Desiree Kunadt
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, Germany
| | - Friedrich Stölzel
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, Germany
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de Molla VC, Heidrich V, Bruno JS, Knebel FH, Miranda-Silva W, Asprino PF, Tucunduva L, Rocha V, Novis Y, Camargo AA, Fregnani ER, Arrais-Rodrigues C. Disruption of the oral microbiota is associated with a higher risk of relapse after allogeneic hematopoietic stem cell transplantation. Sci Rep 2021; 11:17552. [PMID: 34475459 PMCID: PMC8413296 DOI: 10.1038/s41598-021-96939-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 08/11/2021] [Indexed: 02/07/2023] Open
Abstract
Intestinal microbiota (IM) diversity and composition regulates host immunity and affects outcomes after allogeneic stem cell transplantation (allo-HSCT). We evaluated if the oral mucosa microbiota (OM) could impact the outcomes in patients who underwent allo-HSCT. Samples from the oral mucosa of 30 patients were collected at three time points: before the conditioning regimen, at aplasia, and at engraftment. We analyzed the associations of OM diversity and composition with allo-HSCT outcomes. Lower OM diversity at preconditioning was associated with a higher risk of relapse at 3 years (68% versus 33%, respectively; P = 0.04). Dominance (relative abundance ≥ 30%) by a single genus at preconditioning was also associated with a higher risk of relapse (63% versus 36% at 3 years, respectively; P = 0.04), as well as worse progression-free survival (PFS; 19% versus 55%, respectively; P = 0.01), and overall survival (OS) at 3 years (38% versus 81%, respectively; P = 0.02). In our study we observed that OM dysbiosis is associated with a higher risk of relapse and worse survival after allo-HSCT.
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Affiliation(s)
- Vinícius Campos de Molla
- Centro de Oncologia, Hospital Sírio Libanês, Rua Dona Adma Jafet, 91, São Paulo, SP, 01308-050, Brazil
- Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Vitor Heidrich
- Centro de Oncologia Molecular, Hospital Sírio Libanês, São Paulo, SP, Brazil
- Departamento de Bioquímica, Instituto de Química, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | | | | | | | - Luciana Tucunduva
- Centro de Oncologia, Hospital Sírio Libanês, Rua Dona Adma Jafet, 91, São Paulo, SP, 01308-050, Brazil
| | - Vanderson Rocha
- Centro de Oncologia, Hospital Sírio Libanês, Rua Dona Adma Jafet, 91, São Paulo, SP, 01308-050, Brazil
- Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo/ICESP, Sao Paulo, Brazil
- Churchill Hospital, NHS-BT, Oxford, UK
| | - Yana Novis
- Centro de Oncologia, Hospital Sírio Libanês, Rua Dona Adma Jafet, 91, São Paulo, SP, 01308-050, Brazil
| | | | | | - Celso Arrais-Rodrigues
- Centro de Oncologia, Hospital Sírio Libanês, Rua Dona Adma Jafet, 91, São Paulo, SP, 01308-050, Brazil.
- Universidade Federal de São Paulo, São Paulo, SP, Brazil.
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Gagelmann N, Kröger N. Dose intensity for conditioning in allogeneic hematopoietic cell transplantation: can we recommend "when and for whom" in 2021? Haematologica 2021; 106:1794-1804. [PMID: 33730842 PMCID: PMC8252938 DOI: 10.3324/haematol.2020.268839] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Indexed: 12/12/2022] Open
Abstract
Allogeneic hematopoietic stem-cell transplantation is a potentially curative therapy for various hematologic diseases. An essential component of this procedure is the pre-transplant conditioning regimen, which should facilitate engraftment and reduce or eliminate tumor cells. The recognition of the substantial association of a graft-versus- tumor effect and the high toxicity of the commonly used conditioning regimen led to the introduction of more differentiated intensity strategies, with the aim of making hematopoietic stem-cell transplantation less toxic and safer, and thus more applicable to broader populations such as older or unfit patients. In general, prospective and retrospective studies suggest a correlation between increasing intensity and nonrelapse mortality and an inverse correlation with relapse incidence. In this review, we will summarize traditional and updated definitions for conditioning intensity strategies and the landscape of comparative prospective and retrospective studies, which may help to find the balance between the risk of non-relapse mortality and relapse. We will try to underscore the caveats regarding these definitions and analyses, by missing complex differences between intensity and toxicity as well as the broad influences of other factors in the transplantation procedure. We will summarize evidence regarding several confounders which may influence decisions when selecting the intensity of the conditioning regimen for any given patient, according to the individual risk of relapse and non-relapse mortality.
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Affiliation(s)
- Nico Gagelmann
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg
| | - Nicolaus Kröger
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg.
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10
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Targeting CD300f to enhance hematopoietic stem cell transplantation in acute myeloid leukemia. Blood Adv 2021; 4:1206-1216. [PMID: 32215656 DOI: 10.1182/bloodadvances.2019001289] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 02/19/2020] [Indexed: 12/11/2022] Open
Abstract
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) significantly reduces the rate of relapse in acute myeloid leukemia (AML) but comes at the cost of significant treatment-related mortality. Despite the reduction in relapse overall, it remains common, especially in high-risk groups. The outcomes for patients who relapse after transplant remains very poor. A large proportion of the morbidity that prevents most patients from accessing allo-HSCT is due to toxic nonspecific conditioning agents that are required to remove recipient hematopoietic stem and progenitor cells (HSPCs), allowing for successful donor engraftment. CD300f is expressed evenly across HSPC subtypes. CD300f has transcription and protein expression equivalent to CD33 on AML. We have developed an anti-CD300f antibody that efficiently internalizes into target cells. We have generated a highly potent anti-CD300f antibody-drug conjugate (ADC) with a pyrrolobenzodiazepine warhead that selectively depletes AML cell lines and colony forming units in vitro. The ADC synergizes with fludarabine, making it a natural combination to use in a minimal toxicity conditioning regimen. Our ADC prolongs the survival of mice engrafted with human cell lines and depletes primary human AML engrafted with a single injection. In a humanized mouse model, a single injection of the ADC depletes CD34+ HSPCs and CD34+CD38-CD90+ hematopoietic stem cells. This work establishes an anti-CD300f ADC as an attractive potential therapeutic that, if validated in transplant models using a larger cohort of primary AML samples, will reduce relapse rate and toxicity for patients with AML undergoing allo-HSCT.
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11
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Loke J, Buka R, Craddock C. Allogeneic Stem Cell Transplantation for Acute Myeloid Leukemia: Who, When, and How? Front Immunol 2021; 12:659595. [PMID: 34012445 PMCID: PMC8126705 DOI: 10.3389/fimmu.2021.659595] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 03/23/2021] [Indexed: 12/28/2022] Open
Abstract
Although the majority of patients with acute myeloid leukemia (AML) treated with intensive chemotherapy achieve a complete remission (CR), many are destined to relapse if treated with intensive chemotherapy alone. Allogeneic stem cell transplant (allo-SCT) represents a pivotally important treatment strategy in fit adults with AML because of its augmented anti-leukemic activity consequent upon dose intensification and the genesis of a potent graft-versus-leukemia effect. Increased donor availability coupled with the advent of reduced intensity conditioning (RIC) regimens has dramatically increased transplant access and consequently allo-SCT is now a key component of the treatment algorithm in both patients with AML in first CR (CR1) and advanced disease. Although transplant related mortality has fallen steadily over recent decades there has been no real progress in reducing the risk of disease relapse which remains the major cause of transplant failure and represents a major area of unmet need. A number of therapeutic approaches with the potential to reduce disease relapse, including advances in induction chemotherapy, the development of novel conditioning regimens and the emergence of the concept of post-transplant maintenance, are currently under development. Furthermore, the use of genetics and measurable residual disease technology in disease assessment has improved the identification of patients who are likely to benefit from an allo-SCT which now represents an increasingly personalized therapy. Future progress in optimizing transplant outcome will be dependent on the successful delivery by the international transplant community of randomized prospective clinical trials which permit examination of current and future transplant therapies with the same degree of rigor as is routinely adopted for non-transplant therapies.
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Affiliation(s)
- Justin Loke
- Centre for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, United Kingdom
- CRUK Clinical Trials Unit, University of Birmingham, Birmingham, United Kingdom
| | - Richard Buka
- Centre for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, United Kingdom
- CRUK Clinical Trials Unit, University of Birmingham, Birmingham, United Kingdom
| | - Charles Craddock
- Centre for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, United Kingdom
- CRUK Clinical Trials Unit, University of Birmingham, Birmingham, United Kingdom
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12
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Terakura S, Konuma T, Tanaka M, Ozawa Y, Onizuka M, Nanno S, Onishi Y, Aotsuka N, Kondo T, Kawakita T, Kato J, Kobayashi T, Nishida T, Yamaguchi T, Kuwatsuka Y, Takahashi S. Randomised controlled trial of conditioning regimen for cord blood transplantation for adult myeloid malignancies comparing high-dose cytarabine/cyclophosphamide/total body irradiation with versus without G-CSF priming: G-CONCORD study protocol. BMJ Open 2020; 10:e040467. [PMID: 33277285 PMCID: PMC7722372 DOI: 10.1136/bmjopen-2020-040467] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION A better long-term quality of life after umbilical cord blood transplantation (CBT) is observed compared with transplants from other alternative donors, whereas graft failure and relapses after CBT are still major issues. To minimise graft failure and relapse after CBT, intensification of conditioning by the addition of high-dose cytosine arabinoside (CA) and concomitant continuous use of granulocyte-colony stimulating factor (G-CSF) are reported to convey a significantly better survival after CBT in some retrospective studies. To confirm the effect of G-CSF plus CA combination, in addition to the standard conditioning regimen, cyclophosphamide (CY)/total body irradiation (TBI), we design a randomised controlled study comparing CA/CY/TBI with versus without G-CSF priming (G-CSF combined conditioned cord blood transplantation [G-CONCORD] study). METHODS AND ANALYSIS This is a multicentre, open-label, randomised phase III study that aimed to compare G-CSF+CA/CY/TBI as a conditioning regimen for CBT with CA/CY/TBI. Patients with acute myeloid leukaemia or myelodysplastic syndrome, aged 16-55 years, are eligible. The target sample size is 160 and the registration period is 4 years. The primary endpoint is the 2-year disease-free survival rate after CBT. The secondary endpoints are overall survival, relapse, non-relapse mortality, acute and chronic graft-versus-host disease, engraftment rate, time to neutrophil recovery, short-term adverse events, incidence of infections and causes of death.This study employs a single one-to-one web-based randomisation between the with-G-CSF versus without-G-CSF groups after patient registration. Combination of high-dose CA and CY/TBI in both groups is used for conditioning. ETHICS AND DISSEMINATION The study protocol was approved by the central review board, Nagoya University Certified Review Board, after the enforcement of the Clinical Trials Act in Japan. The manuscripts presenting data from this study will be submitted for publication in quality peer-reviewed medical journals. Study findings will be disseminated via presentations at national/international conferences and peer-reviewed journals. TRIAL REGISTRATION NUMBERS UMIN000029947 and jRCTs041180059.
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Affiliation(s)
- Seitaro Terakura
- Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takaaki Konuma
- Department of Hematology/Oncology, The Institute of Medical Science The University of Tokyo, Tokyo, Japan
| | - Masatsugu Tanaka
- Department of Hematology, Kanagawa Cancer Center, Yokohama, Japan
| | - Yukiyasu Ozawa
- Department of Hematology and Oncology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan
| | - Makoto Onizuka
- Department of Hematology and Oncology, Tokai University School of Medicine Graduate School of Medicine, Isehara, Japan
| | - Satoshi Nanno
- Department of Hematology, Osaka City University Graduate School of Medicine School of Medicine, Osaka, Japan
| | - Yasushi Onishi
- Department of Hematology and Rheumatology, Tohoku University Hospital, Sendai, Japan
| | - Nobuyuki Aotsuka
- Division of Hematology-Oncology, Japanese Red Cross Society Narita Hospital, Narita, Japan
| | - Tadakazu Kondo
- Department of Hematology and Oncology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Toshiro Kawakita
- Department of Hematology, National Hospital Organisation Kumamoto Medical Center, Kumamoto, Japan
| | - Jun Kato
- Division of Hematology, Keio University School of Medicine, Tokyo, Japan
| | - Takeshi Kobayashi
- Division of Hematology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Tetsuya Nishida
- Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takuhiro Yamaguchi
- Department of Biostatistics, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Yachiyo Kuwatsuka
- Department of Advanced Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Satoshi Takahashi
- Department of Hematology/Oncology, The Institute of Medical Science The University of Tokyo, Tokyo, Japan
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13
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Bejanyan N, Zhang M, Bo-Subait K, Brunstein C, Wang H, Warlick ED, Giralt S, Nishihori T, Martino R, Passweg J, Dias A, Copelan E, Hale G, Gale RP, Solh M, Kharfan-Dabaja MA, Diaz MA, Ganguly S, Gore S, Verdonck LF, Hossain NM, Kekre N, Savani B, Byrne M, Kanakry C, Cairo MS, Ciurea S, Schouten HC, Bredeson C, Munker R, Lazarus H, Cahn JY, van Der Poel M, Rizzieri D, Yared JA, Freytes C, Cerny J, Aljurf M, Palmisiano ND, Pawarode A, Bacher VU, Grunwald MR, Nathan S, Wirk B, Hildebrandt GC, Seo S, Olsson RF, George B, de Lima M, Hourigan CS, Sandmaier BM, Litzow M, Kebriaei P, Saber W, Weisdorf D. Myeloablative Conditioning for Allogeneic Transplantation Results in Superior Disease-Free Survival for Acute Myelogenous Leukemia and Myelodysplastic Syndromes with Low/Intermediate but not High Disease Risk Index: A Center for International Blood and Marrow Transplant Research Study. Transplant Cell Ther 2020; 27:68.e1-68.e9. [PMID: 33010430 DOI: 10.1016/j.bbmt.2020.09.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 09/05/2020] [Accepted: 09/19/2020] [Indexed: 11/26/2022]
Abstract
Compared with reduced-intensity conditioning (RIC), myeloablative conditioning (MAC) is generally associated with lower relapse risk after allogeneic hematopoietic cell transplantation (HCT) for acute myelogenous leukemia (AML) and myelodysplastic syndromes (MDS). However, disease-specific risk factors in AML/MDS can further inform when MAC and RIC may yield differential outcomes. We analyzed HCT outcomes stratified by the Disease Risk Index (DRI) in 4387 adults (age 40 to 65 years) to identify the impact of conditioning intensity. In the low/intermediate-risk DRI cohort, RIC was associated with lower nonrelapse mortality (NRM) (hazard ratio [HR], .74; 95% confidence interval [CI], .62 to .88; P < .001) but significantly greater relapse risk (HR, 1.54; 95% CI, 1.35 to 1.76; P < .001) and thus inferior disease-free survival (DFS) (HR, 1.19; 95% CI, 1.07 to 1.33; P = .001). In the high/very high-risk DRI cohort, RIC was associated with marginally lower NRM (HR, .83; 95% CI, .68 to 1.00; P = .051) and significantly higher relapse risk (HR, 1.23; 95% CI, 1.08 to 1.41; P = .002), leading to similar DFS using either RIC or MAC. These data support MAC over RIC as the preferred conditioning intensity for patients with AML/MDS with low/intermediate-risk DRI, but with a similar benefit as RIC in high/very high-risk DRI. Novel MAC regimens with less toxicity could benefit all patients, but more potent antineoplastic approaches are needed for the high/very-high risk DRI group.
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Affiliation(s)
- Nelli Bejanyan
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, Florida.
| | - Meijie Zhang
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Khalid Bo-Subait
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Claudio Brunstein
- Adult Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota
| | - Hailin Wang
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Erica D Warlick
- Adult Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota
| | - Sergio Giralt
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Taiga Nishihori
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, Florida
| | - Rodrigo Martino
- Division of Clinical Hematology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Jakob Passweg
- Division of Hematology, Department of Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - Ajoy Dias
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Edward Copelan
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health, Charlotte, North Carolina
| | - Gregory Hale
- Department of Hematology/Oncology, Johns Hopkins All Children's Hospital, St Petersburg, Florida
| | - Robert Peter Gale
- Haematology Research Centre, Department of Immunology and Inflammation, Imperial College London, London, UK
| | - Melhem Solh
- Blood and Marrow Transplant Group of Georgia, Northside Hospital, Atlanta, Georgia
| | - Mohamed A Kharfan-Dabaja
- Division of Hematology-Oncology, Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, Florida
| | - Miguel Angel Diaz
- Department of Hematology/Oncology, Hospital Infantil Universitario Nino Jesus, Madrid, Spain
| | - Siddhartha Ganguly
- Division of Hematological Malignancy and Cellular Therapeutics, University of Kansas Health System, Kansas City, Kansas
| | - Steven Gore
- Section of Medical Oncology, Department of Internal Medicine, Yale New Haven Hospital, New Haven, Connecticut
| | - Leo F Verdonck
- Department of Hematology/Oncology, Isala Clinic, Zwolle, The Netherland
| | - Nasheed M Hossain
- Stem Cell Transplant Program, Division of Hematology/Oncology, Department of Medicine, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois
| | - Natasha Kekre
- Blood & Marrow Transplant Program, Department of Medicine, Ottawa Hospital Ottawa, Ontario, Canada
| | - Bipin Savani
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Michael Byrne
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Christopher Kanakry
- Experimental Transplantation and Immunology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Mitchell S Cairo
- Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Department of Pediatrics, New York Medical College, Valhalla, New York
| | - Stefan Ciurea
- Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Harry C Schouten
- Department of Hematology, Academische Ziekenhuis, Maastricht, The Netherlands
| | - Christopher Bredeson
- Blood & Marrow Transplant Program, Department of Medicine, Ottawa Hospital Ottawa, Ontario, Canada
| | - Reinhold Munker
- Division of Medical Oncology, Markey Cancer Center, University of Kentucky School of Medicine, Lexington, Kentucky
| | - Hillard Lazarus
- Department of Medicine, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Jean-Yves Cahn
- Department of Hematology, CHU Grenoble Alpes, Grenoble, France
| | - Marjolein van Der Poel
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - David Rizzieri
- Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, North Carolina
| | - Jean A Yared
- Blood & Marrow Transplantation Program, Division of Hematology/Oncology, Department of Medicine, Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, Maryland
| | - Cesar Freytes
- Hematopoietic Stem Cell Transplant Program, Texas Transplant Institute, San Antonio, Texas
| | - Jan Cerny
- Division of Hematology/Oncology, Department of Medicine, University of Massachusetts Medical Center, Worcester, Massachusetts
| | - Mahmoud Aljurf
- Department of Oncology, King Faisal Specialist Hospital Center & Research, Riyadh, Saudi Arabia
| | - Neil D Palmisiano
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Attaphol Pawarode
- Blood and Marrow Transplantation Program, Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Vera Ulrike Bacher
- Department of Hematology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Michael R Grunwald
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health, Charlotte, North Carolina
| | - Sunita Nathan
- Section of Bone Marrow Transplantation and Cellular Therapy, Division of Hematology, Oncology and Cell Therapy, Department of Internal Medicine, Rush Medical College, Chicago, Illinois
| | - Baldeep Wirk
- Bone Marrow Transplant Program, Penn State Cancer Institute, Hershey, Pennsylvania
| | - Gerhard C Hildebrandt
- Division of Medical Oncology, Markey Cancer Center, University of Kentucky School of Medicine, Lexington, Kentucky
| | - Sachiko Seo
- Department of Hematology and Oncology, Dokkyo Medical University, Tochigi, Japan
| | - Richard F Olsson
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Clinical Research Sormland, Uppsala University, Sweden
| | - Biju George
- Department of Haematology, Christian Medical College, Vellore, India
| | - Marcos de Lima
- Department of Medicine, Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, Ohio
| | - Christopher S Hourigan
- Laboratory of Myeloid Malignancies, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Brenda M Sandmaier
- Division of Medical Oncology, University of Washington and Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Mark Litzow
- Division of Hematology and Transplant Center, Mayo Clinic Rochester, Rochester, Minnesota
| | - Partow Kebriaei
- Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Wael Saber
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Daniel Weisdorf
- Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, 96
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14
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Predicting non-relapse mortality following allogeneic hematopoietic cell transplantation during first remission of acute myeloid leukemia. Bone Marrow Transplant 2020; 56:387-394. [PMID: 32796950 DOI: 10.1038/s41409-020-01032-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/31/2020] [Accepted: 08/06/2020] [Indexed: 11/08/2022]
Abstract
The aim of this study was to develop a comprehensive system for predicting non-relapse mortality after allogeneic hematopoietic cell transplantation (HCT) during first complete remission (CR) of acute myeloid leukemia (AML). After dividing 2344 eligible patients randomly into a training set and a validation set, we first identified and scored five parameters, that is, age, sex, performance status, HCT-comorbidity index (HCT-CI), and donor type, on the basis of their impact on non-relapse mortality for patients in the training set. The non-relapse mortality-J (NRM-J) index using the sum of these scores was then applied to patients in the validation set, resulting in a clear differentiation of non-relapse mortality, with expected 2-year rates of 11%, 16%, 27%, and 33%, respectively (P < 0.001). The estimated c-statistic was 0.67, which was significantly higher than that of the European Society for Blood and Marrow Transplantation score (0.60, P = 0.002) and the HCT-CI (0.57, P < 0.001). The NRM-J index showed a significant association with overall survival, but not with relapse. Our findings demonstrate that the NRM-J index is useful for predicting post-transplant non-relapse mortality for patients with AML in first CR, for whom the decision of whether to perform allogeneic HCT is critical.
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15
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Ma S, Shi W, Li Z, Tang L, Wang H, Xia L, Hu Y. Reduced-intensity versus Myeloablative Conditioning Regimens for Younger Adults with Acute Myeloid Leukemia and Myelodysplastic Syndrome: A systematic review and meta-analysis. J Cancer 2020; 11:5223-5235. [PMID: 32742468 PMCID: PMC7378925 DOI: 10.7150/jca.46081] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 06/15/2020] [Indexed: 01/06/2023] Open
Abstract
Background: Historically, reduced-intensity conditioning (RIC) was recommended to be performed for older patients who were considered ineligible for myeloablative conditioning (MAC) before allogeneic hematopoietic stem cell transplantation (allo-HSCT). However, the evidence regarding the optimal conditioning intensity in younger patients with AML or MDS is weak and contradictory. Methods: PubMed, Medline, Embase, and other online sources were searched from the initial period to February 25, 2020. Odds ratios and 95% confidence intervals were calculated to estimate pooling effects. Results: Four randomized controlled trials (RCTs) about conditioning intensity involving 633 patients were included. There were no significant differences of 1/2/4/5 years progression-free survival (PFS) and relapse incidence (RI) between two conditioning intensities. Overall survival (OS) was similar at 1/2/4 years, but patients receiving RIC had a higher OS at 5 years. Additionally, RIC were associated with lower non-relapse mortality, less grade II-IV and grade III-IV acute graft-versus-host disease (GVHD), and lower incidence of chronic GVHD compared with MAC regimens. Subgroup analysis showed similar OS and RI for AML patients, and there was a trend towards lower NRM and grade II-IV aGVHD in RIC group. Available data for MDS indicated that OS, PFS, and RI were comparable. For intermediate-risk patients, there was no evidence that RIC is inferior to MAC. However, for high-risk patients, MAC tends to perform better. Conclusions: Based on the above results, it might be concluded that RIC is a feasible treatment option for adults with AML or MDS younger than 66 years, particularly those with intermediate-risk disease. Future RCTs incorporating of risk stratifications are warranted to guide the optimal decision under certain conditions.
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Affiliation(s)
- Shengling Ma
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Shi
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1024, USA
| | - Ziying Li
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liang Tang
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Huafang Wang
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Linghui Xia
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yu Hu
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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16
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Yanada M, Fukuda T, Tanaka M, Ota S, Toya T, Mori T, Uchida N, Ozawa Y, Nakamae H, Kanda Y, Ichinohe T, Atsuta Y, Yano S. Long-term results of reduced-intensity conditioning allogeneic hematopoietic cell transplantation for older patients with acute myeloid leukemia: a retrospective analysis of 10-year follow-up data. Bone Marrow Transplant 2020; 55:2008-2016. [PMID: 32203266 DOI: 10.1038/s41409-020-0868-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 03/09/2020] [Accepted: 03/10/2020] [Indexed: 11/09/2022]
Abstract
The long-term outcomes of allogeneic hematopoietic cell transplantation (HCT) with reduced-intensity conditioning (RIC) remain inconclusive. To address this issue, we conducted a nationwide registry-based study of patients with acute myeloid leukemia (AML) age 50 years or older who underwent allogeneic HCT in complete remission using RIC (n = 284) or myeloablative conditioning (MAC, n = 190) between 2002 and 2007. The median follow-up period for surviving patients was 10.1 years for RIC recipients and 10.4 years for MAC recipients. The 10-year probabilities of overall survival, relapse, and non-relapse mortality were 36.4%, 30.0%, and 35.7% for RIC recipients, and 39.8%, 26.3%, and 35.5% for MAC recipients, respectively. Multivariate analysis revealed that the conditioning intensity did not affect overall mortality (P = 0.184), relapse (P = 0.904), or non-relapse mortality (P = 0.387). For the 218 patients qualifying for propensity score-matched pairing (109 pairs), RIC was found to be associated with similar survival (P = 0.095) and relapse (P = 0.467), and significantly lower non-relapse mortality (P = 0.046) compared with MAC. Our results confirm the long-term efficacy of RIC allogeneic HCT for older patients with AML and mitigate concerns over an increase in late relapse.
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Affiliation(s)
| | | | | | | | - Takashi Toya
- Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | | | | | | | - Hirohisa Nakamae
- Graduate School of Medicine, Osaka City University, Osaka, Japan
| | | | - Tatsuo Ichinohe
- Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Yoshiko Atsuta
- Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan.,Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shingo Yano
- The Jikei University School of Medicine, Tokyo, Japan
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17
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Impact of prophylactic/preemptive donor lymphocyte infusion and intensified conditioning for relapsed/refractory leukemia: a real-world study. SCIENCE CHINA-LIFE SCIENCES 2020; 63:1552-1564. [PMID: 32086670 DOI: 10.1007/s11427-019-1610-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 01/16/2020] [Indexed: 12/24/2022]
Abstract
Prophylactic/preemptive donor lymphocyte infusion (p/pDLI) and intensified conditioning have shown promising results in experimental studies of refractory/relapsed acute leukemia (RRAL), but real-world data remain scarce. We conducted a multicenter, population-based analysis of 932 consecutive patients. The three-year leukemia-free survival (LFS) rates were 56% for patients receiving both p/pDLI and intensified myeloablative conditioning (MAC) (intenseMAC) and 30% for those who received neither therapy per landmark analysis. Multivariable analyses were run separately for acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL), and p/pDLI treatment was linked to significantly higher LFS than non-DLI for both AML and ALL patients without increasing the nonrelapse mortality. IntenseMAC was associated with significantly lower relapse and higher LFS than nonintensified MAC despite higher nonrelapse mortality rates in ALL, while there was no impact of intenseMAC observed in AML. p/pDLI achieved superior outcomes in both matched-sibling donor (MSD) and haploidentical donor transplantation, while intenseMAC only influenced MSD outcomes. Data suggest that RRAL patients receiving "total therapy" by way of p/pDLI and intensified conditioning treatment have an improved chance for LFS, with p/pDLI being safer with a more extensive impact relative to intenseMAC. Patients with RRAL can tolerate both interventions and achieve a reasonable outcome.
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18
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Redefining and measuring transplant conditioning intensity in current era: a study in acute myeloid leukemia patients. Bone Marrow Transplant 2020; 55:1114-1125. [DOI: 10.1038/s41409-020-0803-y] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 11/30/2019] [Accepted: 01/16/2020] [Indexed: 12/18/2022]
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19
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Loke J, Malladi R, Moss P, Craddock C. The role of allogeneic stem cell transplantation in the management of acute myeloid leukaemia: a triumph of hope and experience. Br J Haematol 2020; 188:129-146. [PMID: 31823351 PMCID: PMC6972492 DOI: 10.1111/bjh.16355] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Acute myeloid leukaemia (AML) is the commonest indication for allogeneic stem cell transplantation (allo-SCT) worldwide. The accumulated experience of allografting in AML over the last four decades has provided critical insights into both the contribution of the conditioning regimen and the graft-versus-leukaemia effect to the curative potential of the most common form of immunotherapy utilised in standard clinical practice. Coupled with advances in donor availability and transplant technologies, this has resulted in allo-SCT becoming an important treatment modality for the majority of adults with high-risk AML. At the same time, advances in genomic classification, coupled with progress in the accurate quantification of measurable residual disease, have increased the precision with which allo-mandatory patients can be identified, whilst simultaneously permitting accurate identification of those patients who can be spared the toxicity of an allograft. Despite this progress, disease recurrence still remains a major cause of transplant failure and AML has served as a paradigm for the development of strategies to reduce the risk of relapse - notably the novel concept of post-transplant maintenance, utilising pharmacological or cellular therapies.
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Affiliation(s)
- Justin Loke
- Centre for Clinical HaematologyQueen Elizabeth HospitalBirminghamUK
- University of BirminghamBirminghamUK
| | - Ram Malladi
- Centre for Clinical HaematologyQueen Elizabeth HospitalBirminghamUK
- University of BirminghamBirminghamUK
| | - Paul Moss
- Centre for Clinical HaematologyQueen Elizabeth HospitalBirminghamUK
- University of BirminghamBirminghamUK
| | - Charles Craddock
- Centre for Clinical HaematologyQueen Elizabeth HospitalBirminghamUK
- University of BirminghamBirminghamUK
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20
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Jentzsch M, Döhring C, Linke R, Hille A, Grimm J, Pönisch W, Vucinic V, Franke G, Behre G, Niederwieser D, Schwind S. Comparison of non-myeloablative and reduced-intensity allogeneic stem cell transplantation in older patients with myelodysplastic syndromes. Am J Hematol 2019; 94:1344-1352. [PMID: 31495933 DOI: 10.1002/ajh.25636] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 08/20/2019] [Accepted: 09/05/2019] [Indexed: 11/07/2022]
Abstract
Allogeneic stem cell transplantation (HSCT) remains the only curative treatment for myelodysplastic syndromes (MDS) or myelodysplastic/myeloproliferative neoplasms (MDS/MPN) patients. The introduction of reduced intensity (RIC) and non-myeloablative (NMA) conditioning enabled HSCT in older or comorbid individuals representing the majority of patients. Studies comparing RIC and NMA conditioning are limited. We retrospectively analyzed 151 MDS or MDS/MPN patients older than 50 years who received NMA- or RIC-HSCT. Patients younger or older than 65 years at HSCT were analyzed separately. Patients receiving RIC-HSCT or NMA-HSCT were balanced in factors reflecting disease aggressiveness and the HCT-CI comorbidity score. The NMA conditioned patients had a higher incidence of graft rejection and chronic graft-vs-host disease. Cumulative incidence of relapse (CIR), non-relapse mortality (NRM) and overall survival (OS), did not differ significantly with regard to the conditioning regime in the whole cohort. In patients <65 years at HSCT, NMA conditioning associated with higher NRM and shorter OS by trend, while CIR was similar in both groups. In multivariable analyzes, the conditioning regimen remained a prognostic factor for NRM and OS in patients <65 years at HSCT. In MDS patients NMA and RIC conditioning result in similar disease control, but especially patients <65 years may benefit from RIC-HSCT.
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Affiliation(s)
- Madlen Jentzsch
- Department of Hematology and Clinical Oncology University of Leipzig Leipzig Germany
| | - Christine Döhring
- Department of Hematology and Clinical Oncology University of Leipzig Leipzig Germany
| | - Richard Linke
- Department of Hematology and Clinical Oncology University of Leipzig Leipzig Germany
| | - Andrea Hille
- Department of Hematology and Clinical Oncology University of Leipzig Leipzig Germany
| | - Juliane Grimm
- Department of Hematology and Clinical Oncology University of Leipzig Leipzig Germany
| | - Wolfram Pönisch
- Department of Hematology and Clinical Oncology University of Leipzig Leipzig Germany
| | - Vladan Vucinic
- Department of Hematology and Clinical Oncology University of Leipzig Leipzig Germany
| | - Georg‐Nikolaus Franke
- Department of Hematology and Clinical Oncology University of Leipzig Leipzig Germany
| | - Gerhard Behre
- Department of Hematology and Clinical Oncology University of Leipzig Leipzig Germany
| | - Dietger Niederwieser
- Department of Hematology and Clinical Oncology University of Leipzig Leipzig Germany
| | - Sebastian Schwind
- Department of Hematology and Clinical Oncology University of Leipzig Leipzig Germany
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Huang JJ, Zhang Y, Liu QF. [Focusing the application of hematopoietic stem cell transplantation in elderly acute myeloid leukemia]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2018; 39:1043-1046. [PMID: 30612411 PMCID: PMC7348226 DOI: 10.3760/cma.j.issn.0253-2727.2018.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Indexed: 11/05/2022]
Affiliation(s)
| | | | - Q F Liu
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
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22
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Harada K, Yanada M, Machida S, Kanamori H, Onizuka M, Ozawa Y, Kobayashi H, Sawa M, Katayama Y, Ohashi K, Kanda J, Ichinohe T, Atsuta Y, Yano S. Prognostic impact of melphalan dose and total body irradiation use in patients with acute myeloid leukemia undergoing allogeneic stem cell transplantation with reduced-intensity conditioning. Leuk Lymphoma 2018; 60:1493-1502. [PMID: 30457400 DOI: 10.1080/10428194.2018.1535115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
To evaluate the prognostic impact of melphalan dose and total body irradiation (TBI) use in acute myeloid leukemia patients undergoing reduced-intensity allogeneic transplantation, we retrospectively compared outcomes of patients receiving a higher-dose (120-140 mg/m2, n = 379) or lower-dose melphalan (80-110 mg/m2, n = 128) with or without TBI of ≤4 Gy. At 3 years, overall survival was 48.9% in the higher-dose group versus 40.3% in the lower-dose group (p = .013). This survival benefit was attributed to lower tumor-related mortality (23.9% vs. 31.7%; p = .049). Non-relapse mortality did not differ (24.8% vs. 23.5%, p = .59). The beneficial effect of a higher-dose melphalan was more evident when combined with TBI in younger patients, those not in complete remission, and those with good performance status. Our findings support the use of a higher-dose melphalan in combination with TBI for reduced-intensity conditioning in physically fit patients.
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Affiliation(s)
- Kaito Harada
- a Department of Hematology and Oncology , Tokai University School of Medicine , Isehara , Japan
| | - Masamitsu Yanada
- b Department of Hematology and Cell Therapy , Aichi Cancer Center , Nagoya , Japan
| | - Shinichiro Machida
- a Department of Hematology and Oncology , Tokai University School of Medicine , Isehara , Japan
| | - Heiwa Kanamori
- c Department of Hematology , Kanagawa Cancer Center , Yokohama , Japan
| | - Makoto Onizuka
- a Department of Hematology and Oncology , Tokai University School of Medicine , Isehara , Japan
| | - Yukiyasu Ozawa
- d Department of Hematology , Japanese Red Cross Nagoya First Hospital , Nagoya , Japan
| | - Hikaru Kobayashi
- e Department of Hematology , Nagano Red Cross Hospital , Nagano , Japan
| | - Masashi Sawa
- f Department of Hematology and Oncology , Anjo Kosei Hospital , Anjo , Japan
| | - Yuta Katayama
- g Department of Hematology , Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital , Hiroshima , Japan
| | - Kazuteru Ohashi
- h Hematology Division , Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital , Tokyo , Japan
| | - Junya Kanda
- i Department of Hematology and Oncology , Graduate School of Medicine, Kyoto University , Kyoto , Japan
| | - Tatsuo Ichinohe
- j Department of Hematology and Oncology , Research Institute for Radiation Biology and Medicine, Hiroshima University , Hiroshima , Japan
| | - Yoshiko Atsuta
- k Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan.,l Department of Healthcare Administration , Nagoya University Graduate School of Medicine , Nagoya , Japan
| | - Shingo Yano
- m Division of Clinical Oncology and Hematology , The Jikei University School of Medicine , Tokyo , Japan
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23
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Solh MM, Solomon SR, Morris LE, Zhang X, Holland HK, Bashey A. The Dilemma of Conditioning Intensity: When Does Myeloablative Conditioning Improve Outcomes for Allogeneic Hematopoietic Cell Transplantation. Biol Blood Marrow Transplant 2018; 25:606-612. [PMID: 30244109 DOI: 10.1016/j.bbmt.2018.09.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 09/10/2018] [Indexed: 02/05/2023]
Abstract
The impact of conditioning intensity on different disease risk index (DRI) groups has not been evaluated. We retrospectively analyzed acute myelogenous leukemia (AML)/myelodysplastic syndrome (MDS) hematopoietic cell transplantation (HCT) recipients in 2 groups based on DRI, to assess the impact of conditioning intensity on overall survival (OS), disease free survival (DFS), relapse, and nonrelapse mortality (NRM). A total of 380 patients with either high/very high (n = 148) or low/intermediate DRI (n = 232) myeloid malignancy (AML, n = 278; MDS, n = 102) were included in the analysis. Median follow-up for survivors was 35 months. Median age was 58years (range, 18 to 75). Patient and transplant-related characteristics were 41% reduced-intensity conditioning (RIC), 59% myeloablative conditioning (MAC), 13% bone marrow graft, 29% matched related donor, 49% matched unrelated donor, 22% haploidentical donor, and 52% HCT-specific comorbidity index ≥ 3. Among patients with high/very high DRI, there was no difference in OS, DFS, relapse, and NRM between RIC and MAC conditioning groups. For low/intermediate risk DRI recipients of MAC had better 3-year OS estimate (69% versus 57%, P = .001), DFS (65% versus 51%, P = .003), and lower relapse (3-year cumulative incidence, 17% versus 32%; P = .01) but similar NRM (19% versus 17%, P = .04) to RIC recipients. On multivariable analysis MAC was associated with better DFS (hazard ratio [HR], .58; 95% confidence interval [CI], .39-.88; P = .01), lower relapse (HR, .56; 95% CI, .32 to .97; P = .038), and similar NRM (HR, 1.11; 95% CI, .54 to 2.26; P = .781) compared with RIC in the low/intermediate DRI group. Intensity had no impact on HCT outcomes in the high/very high DRI group. MAC improves DFS and relapse compared with RIC among AML/MDS patients with low/intermediate DRI. The finding of no such benefit in high/very high DRI needs to be further explored in a larger cohort with a longer follow-up.
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Affiliation(s)
- Melhem M Solh
- Blood and Marrow Transplant Program at Northside Hospital, Atlanta Georgia.
| | - Scott R Solomon
- Blood and Marrow Transplant Program at Northside Hospital, Atlanta Georgia
| | - Lawrence E Morris
- Blood and Marrow Transplant Program at Northside Hospital, Atlanta Georgia
| | - Xu Zhang
- Center for Clinical and Translational Sciences, University of Texas Health Science Center at Houston, Houston, Texas
| | - H Kent Holland
- Blood and Marrow Transplant Program at Northside Hospital, Atlanta Georgia
| | - Asad Bashey
- Blood and Marrow Transplant Program at Northside Hospital, Atlanta Georgia; Center for Clinical and Translational Sciences, University of Texas Health Science Center at Houston, Houston, Texas
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24
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The consensus on the monitoring, treatment, and prevention of leukemia relapse after allogeneic hematopoietic stem cell transplantation in China. Cancer Lett 2018; 438:63-75. [PMID: 30217562 DOI: 10.1016/j.canlet.2018.08.030] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 07/29/2018] [Accepted: 08/28/2018] [Indexed: 02/05/2023]
Abstract
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is an important curative therapy for patients with leukemia. However, relapse remains the leading cause of death after transplantation. In recent years, substantial progress has been made by Chinese physicians in the field of establishment of novel transplant modality, patient selection, minimal residual disease (MRD) monitoring, and immunological therapies, such as modified donor lymphocyte infusion (DLI) and chimeric antigen receptor T (CART) cells, as well as MRD-directed intervention for relapse. Most of these unique systems are distinct from those in the Western world. In this consensus, we reviewed the efficacy of post-HSCT relapse management practice from available Chinese studies on behalf of the HSCT workgroup of the Chinese Society of Hematology, Chinese Medical Association, and compared these studies withthe consensus or guidelines outside China. We summarized the consensus on routine practices of post-HSCT relapse management in China and focused on the recommendations of MRD monitoring, risk stratification directed strategies, and modified DLI system. This consensus will likely contribute to the standardization of post-HSCT relapse management in China and become an inspiration for further international cooperation to refine global practices.
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25
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Gilleece MH, Labopin M, Yakoub-Agha I, Volin L, Socié G, Ljungman P, Huynh A, Deconinck E, Wu D, Bourhis JH, Cahn JY, Polge E, Mohty M, Savani BN, Nagler A. Measurable residual disease, conditioning regimen intensity, and age predict outcome of allogeneic hematopoietic cell transplantation for acute myeloid leukemia in first remission: A registry analysis of 2292 patients by the Acute Leukemia Working Party European Society of Blood and Marrow Transplantation. Am J Hematol 2018; 93:1142-1152. [PMID: 29981272 DOI: 10.1002/ajh.25211] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 06/13/2018] [Accepted: 06/18/2018] [Indexed: 12/26/2022]
Abstract
Patients with acute myeloid leukemia (AML) in morphological first complete remission (CR1) pre-allogeneic hematopoietic cell transplantation (HCT) may have measurable residual disease (MRD) by molecular and immunophenotyping criteria. We assessed interactions of MRD status with HCT conditioning regimen intensity in patients aged <50 years (y) or ≥50y. This was a retrospective study by the European Society for Blood and Marrow Transplantation registry. Patients were >18y with AML CR1 MRD NEG/POS and recipients of HCT in 2000-2015. Conditioning regimens were myeloablative (MAC), reduced intensity (RIC) or non-myeloablative (NMA). Outcomes included leukemia free survival (LFS), overall survival (OS), relapse incidence (RI), non-relapse mortality (NRM), chronic graft-vs-host (cGVHD), and GVHD-free and relapse-free survival (GRFS). The 2292 eligible patients were categorized into four paired groups: <50y MRD POS MAC (N = 240) vs RIC/NMA (N = 58); <50y MRD NEG MAC (N = 665) vs RIC/NMA (N = 195); ≥50y MRD POS MAC (N = 126) vs RIC/NMA (N = 230), and ≥50y MRD NEG MAC (N = 223) vs RIC/NMA (N = 555). In multivariate analysis RIC/NMA was only inferior to MAC for patients in the <50y MRD POS group, with worse RI (HR 1.71) and LFS (HR 1.554). Patients <50Y MRD NEG had less cGVHD after RIC/NMA HCT (HR 0.714). GRFS was not significantly affected by conditioning intensity in any group. Patients aged <50y with AML CR1 MRD POS status should preferentially be offered MAC allo-HCT. Prospective studies are needed to address whether patients with AML CR1 MRD NEG may be spared the toxicity of MAC regimens. New approaches are needed for ≥50y AML CR1 MRD POS.
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Affiliation(s)
- Maria H. Gilleece
- Department of Haematology; Leeds Teaching Hospitals Trust, University of Leeds; Leeds United Kingdom
| | | | | | - Liisa Volin
- Comprehensive Cancer Center, Stem Cell Transplantation Unit; Helsinki University Hospital; Helsinki Finland
| | - Gerard Socié
- Service d'Hématologie Greffe; Hôpital Saint-Louis, Assistance Publique Hôpitaux de Paris; Paris France
| | - Per Ljungman
- Center for Allogeneic Stem Cell Transplantation, Karolinska University Hospital; Stockholm Sweden
| | - Anne Huynh
- Service d'Hématologie, Institut Universitaire du Cancer de Toulouse Oncopole; Toulouse France
| | - Eric Deconinck
- Hematology Department; CHRU Besancon, INSERM UMR1098, Universite de Franche-Comte; Besancon France
| | - Depei Wu
- Department of Hematology; First Affiliated Hospital of Soochow University; Suzhou Jiangsu China
| | | | - Jean Yves Cahn
- Department of Haematology, Centre Hospital; Universitaire Grenoble Alpes; Grenoble France
| | - Emmanuelle Polge
- Acute Leukemia Working Party; European Society for Blood and Marrow Transplantation Paris Study Office/European Center for Biostatistical and Epidemiological Evaluation in Hematopoietic Cell Therapy (CEREST-TC); Paris France
| | - Mohamad Mohty
- Hopital Saint-Antoine, Université Pierre and Marie Curie, Institut National de la Santé et de la Recherche Médicale Unite Mixte de Recherche U938; Paris France
| | - Bipin N. Savani
- Division of Hematology/Oncology, Department of Internal Medicine; Vanderbilt University Medical Center; Nashville Tennessee
| | - Arnon Nagler
- Chaim Sheba Medical Center; Tel Aviv University; Tel-Hashomer Israel
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26
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Zhang R, Lu X, Wang H, You Y, Zhong Z, Zang S, Zhang C, Shi W, Li J, Wu Q, Fang J, Xia L. Idarubicin-Intensified Hematopoietic Cell Transplantation Improves Relapse and Survival of High-Risk Acute Leukemia Patients with Minimal Residual Disease. Biol Blood Marrow Transplant 2018; 25:47-55. [PMID: 30031936 DOI: 10.1016/j.bbmt.2018.07.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 07/13/2018] [Indexed: 12/14/2022]
Abstract
The optimal conditioning regimen of allogeneic hematopoietic stem cell transplantation (allo-HSCT) for high-risk patients with minimal residual disease (MRD) remains controversial. We studied the results in 98 high-risk acute leukemia patients transplanted with idarubicin (IDA)-intensified conditioning regimens between 2012 January and 2017 January. Among these patients, 31 (31.6%) had more than 5% marrow blasts at time of transplantation and 67 patients were in morphologic remission: MRD negative status at time of conditioning was achieved in 39 patients (39.8%), whereas 28 (28.6%) remained carriers of any other positive MRD level in the bone marrow. Three-year relapse estimates of patients with MRD-positive remission was 22.0%, which was remarkably lower than patients with active disease (45.4%, P = .027) but approximate to that of patients in MRD-negative remission (15.5%, P = .522). There were no significant differences in terms of 3-year estimated overall survival (OS) and disease-free survival (DFS) between MRD-positive remission and MRD-negative remission groups (71.4% versus 79.1% [P = .562] and 67.9% versus 76.9% [P = .634], respectively). Moreover, the estimated rates of 3-year OS and DFS of patients in MRD-positive remission were significantly better than those in patients with active disease (71.4% versus 41.9% [P = .033] and 67.9% versus 38.7% [P = .037], respectively). These data indicate that IDA-intensified conditioning allo-HSCT could overcome the negative prognostic impact of MRD.
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Affiliation(s)
- Ran Zhang
- Department of Hematology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xuan Lu
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Huafang Wang
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yong You
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhaodong Zhong
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Sibin Zang
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chun Zhang
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Shi
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Junying Li
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qiuling Wu
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jun Fang
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Linghui Xia
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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27
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Lipof JJ, Loh KP, O'Dwyer K, Liesveld JL. Allogeneic Hematopoietic Cell Transplantation for Older Adults with Acute Myeloid Leukemia. Cancers (Basel) 2018; 10:cancers10060179. [PMID: 29866998 PMCID: PMC6025016 DOI: 10.3390/cancers10060179] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 05/30/2018] [Accepted: 06/01/2018] [Indexed: 12/17/2022] Open
Abstract
Acute myeloid leukemia (AML) is a disease that affects adults aged 65 years and above, and survival in this population is poor. Allogeneic hematopoietic cell transplantation (allo-HCT) is a potentially curative therapy for these patients but is underutilized due to frequent comorbidities and perceived higher risk of treatment-related mortality and non-relapse mortality. Increasing data supports the utility of allo-HCT in fit older patients after intensive chemotherapy resulting in improvement of outcomes. With the development of reduced intensity and non-myeloablative conditioning regimens that are associated with lower rates of treatment-related toxicity and mortality, this has allowed more older patients with AML to receive allo-HCT. In this review, we provide some guidance on appropriate selection of older patients as transplant candidates, benefits and risks associated with allo-HCT, conditioning regimen choice, and stem cell transplant sources as they relate to the conduct of stem cell transplantation in older patients.
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Affiliation(s)
- Jodi J Lipof
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, 601 Elmwood Avenue, P.O. Box 704, Rochester, NY 14642, USA.
| | - Kah Poh Loh
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, 601 Elmwood Avenue, P.O. Box 704, Rochester, NY 14642, USA.
| | - Kristen O'Dwyer
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, 601 Elmwood Avenue, P.O. Box 704, Rochester, NY 14642, USA.
| | - Jane L Liesveld
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, 601 Elmwood Avenue, P.O. Box 704, Rochester, NY 14642, USA.
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28
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Current status and future clinical directions in the prevention and treatment of relapse following hematopoietic transplantation for acute myeloid and lymphoblastic leukemia. Bone Marrow Transplant 2018; 54:6-16. [DOI: 10.1038/s41409-018-0203-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 04/02/2018] [Accepted: 04/06/2018] [Indexed: 12/17/2022]
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Comparison of reduced intensity conditioning regimens used in patients undergoing hematopoietic stem cell transplantation for myelofibrosis. Bone Marrow Transplant 2018; 54:204-211. [PMID: 29795431 DOI: 10.1038/s41409-018-0226-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 04/23/2018] [Accepted: 04/24/2018] [Indexed: 02/06/2023]
Abstract
The aim of this study is to compare clinical outcomes of patients who underwent allogeneic stem cell transplantation (HCT) for myelofibrosis with reduced intensity conditioning (RIC) using either Busulfan Fludarabine (BuFlu), Fludarabine Bis-chlorethyl-nitroso-urea/ carmustine Melphalan (FBM) or Fludarabine Melphalan (FluMel) regimens. Sixty-one patients were identified who underwent HCT with one of these RIC regimens. Overall survival (OS) was not different in the 3 groups. However, 100% donor chimerism was seen in more frequently at day +30 and day +100 in patients who received FBM or FluMel than BuFlu, in both CD3 and CD33 fractions. For instance, 100% donor chimerism in CD33 fraction was present in 100% patients in FBM cohort, 90% in FluMel cohort while 44% in BuFlu cohort at day +100. Acute graft-versus host disease, grade 2-4 and grade 3-4, was not statistically different in the 3 groups (BuFlu 47 and 35%, FBM 68 and 27%, FluMel 68 and 46%; p = 0.31 and 0.45). Relapses and non-relapse mortality was also not statistically significantly different. Our study shows similar OS with these 3 RIC regimens in myelofibrosis; although donor chimerism at day +30 and day +100 was better in patients who received FBM and FluMel.
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Bill M, Grimm J, Jentzsch M, Kloss L, Goldmann K, Schulz J, Beinicke S, Häntschel J, Cross M, Vucinic V, Pönisch W, Behre G, Franke GN, Lange T, Niederwieser D, Schwind S. Digital droplet PCR-based absolute quantification of pre-transplant NPM1 mutation burden predicts relapse in acute myeloid leukemia patients. Ann Hematol 2018; 97:1757-1765. [DOI: 10.1007/s00277-018-3373-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Accepted: 05/12/2018] [Indexed: 12/24/2022]
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31
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Kobbe G, Schroeder T, Haas R, Germing U. The current and future role of stem cells in myelodysplastic syndrome therapies. Expert Rev Hematol 2018; 11:411-422. [DOI: 10.1080/17474086.2018.1452611] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Guido Kobbe
- Medical Faculty, Department of Hematology, Oncology and Clinical Immunology, Heinrich Heine University, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Thomas Schroeder
- Medical Faculty, Department of Hematology, Oncology and Clinical Immunology, Heinrich Heine University, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Rainer Haas
- Medical Faculty, Department of Hematology, Oncology and Clinical Immunology, Heinrich Heine University, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Ulrich Germing
- Medical Faculty, Department of Hematology, Oncology and Clinical Immunology, Heinrich Heine University, University Hospital Düsseldorf, Düsseldorf, Germany
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32
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Total Marrow Lymphoid Irradiation/Fludarabine/ Melphalan Conditioning for Allogeneic Hematopoietic Cell Transplantation. Biol Blood Marrow Transplant 2018; 24:301-307. [DOI: 10.1016/j.bbmt.2017.09.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 09/30/2017] [Indexed: 12/16/2022]
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33
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Kröger N, Iacobelli S, Franke GN, Platzbecker U, Uddin R, Hübel K, Scheid C, Weber T, Robin M, Stelljes M, Afanasyev B, Heim D, Deliliers GL, Onida F, Dreger P, Pini M, Guidi S, Volin L, Günther A, Bethge W, Poiré X, Kobbe G, van Os M, Brand R, de Witte T. Dose-Reduced Versus Standard Conditioning Followed by Allogeneic Stem-Cell Transplantation for Patients With Myelodysplastic Syndrome: A Prospective Randomized Phase III Study of the EBMT (RICMAC Trial). J Clin Oncol 2017; 35:2157-2164. [PMID: 28463633 DOI: 10.1200/jco.2016.70.7349] [Citation(s) in RCA: 148] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To compare a reduced-intensity conditioning regimen (RIC) with a myeloablative conditioning regimen (MAC) before allogeneic transplantation in patients with myelodysplastic syndrome (MDS) within a randomized trial. Patients and Methods Within the European Society of Blood and Marrow Transplantation, we conducted a prospective, multicenter, open-label, randomized phase III trial that compared a busulfan-based RIC with MAC in patients with MDS or secondary acute myeloid leukemia. A total of 129 patients were enrolled from 18 centers. Patients were randomly assigned in a 1:1 ratio and were stratified according to donor, age, and blast count. Results Engraftment was comparable between both groups. The CI of acute graft-versus-host disease II to IV was 32.3% after RIC and 37.5% after MAC ( P = .35). The CI of chronic graft-versus-host disease was 61.6% after RIC and 64.7% after MAC ( P = .76). The CI of nonrelapse mortality after 1 year was 17% (95% CI, 8% to 26%) after RIC and 25% (95% CI, 15% to 36%) after MAC ( P = .29). The CI of relapse at 2 years was 17% (95% CI, 8% to 26%) after RIC and 15% (95% CI, 6% to 24%) after MAC ( P = .6), which resulted in a 2-year relapse-free survival and overall survival of 62% (95% CI, 50% to 74%) and 76% (95% CI, 66% to 87%), respectively, after RIC, and 58% (95% CI, 46% to 71%) and 63% (95% CI, 51% to 75%), respectively, after MAC ( P = .58 and P = .08, respectively). Conclusion This prospective, randomized trial of the European Society of Blood and Marrow Transplantation provides evidence that RIC resulted in at least a 2-year relapse-free survival and overall survival similar to MAC in patients with MDS or secondary acute myeloid leukemia.
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Affiliation(s)
- Nicolaus Kröger
- Nicolaus Kröger, University Medical Center Hamburg-Eppendorf, Hamburg; Georg-Nikolaus Franke, University Hospital Leipzig, Leipzig; Uwe Platzbecker, University Hospital Dresden, Dresden; Kai Hübel and Christof Scheid, University of Cologne, Cologne; Thomas Weber, University Hospital Halle (Saale), Martin-Luther-University Halle-Wittenberg, Halle; Matthias Stelljes, University of Münster, Münster; Peter Dreger, University of Heidelberg, Heidelberg; Andreas Günther, University Hospital Schleswig Holstein Campus Kiel, Kiel; Wolfgang Bethge, University Hospital Tübingen, Tübingen; Guido Kobbe, Heinrich Heine University, Düsseldorf, Germany; Simona Iacobelli, Università Tor Vergata, Rome; Giorgio Lambertenghi Deliliers and Francesco Onida, Fondazione IRCC Ca' Granda Ospedale Maggiore Policlinico, University of Milano, Milan; Massimo Pini, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria; Stefano Guidi, Azienda Ospedaliera Universitaria Careggi, Florence, Italy; Ruzena Uddin, Guy's Hospital, London, United Kingdom; Marie Robin, Hôpital Saint Louis, Assistance Publique Hôpitaux Paris, France; Boris Afanasyev, SPB Pavlov Medical University, St Petersburg, Russia; Dominik Heim, University Hospital Basel, Basel Switzerland; Liisa Volin, Helsinki University Hospital, Helsiniki, Finland; Xavier Poiré, Cliniques Universitaires St-Luc, Brussels, Belgium; Marleen van Os, European Group of Blood and Marrow Transplantation Clinical Trials Office; Ronald Brand, Leiden University Medical Center, Leiden; and Theo de Witte, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Simona Iacobelli
- Nicolaus Kröger, University Medical Center Hamburg-Eppendorf, Hamburg; Georg-Nikolaus Franke, University Hospital Leipzig, Leipzig; Uwe Platzbecker, University Hospital Dresden, Dresden; Kai Hübel and Christof Scheid, University of Cologne, Cologne; Thomas Weber, University Hospital Halle (Saale), Martin-Luther-University Halle-Wittenberg, Halle; Matthias Stelljes, University of Münster, Münster; Peter Dreger, University of Heidelberg, Heidelberg; Andreas Günther, University Hospital Schleswig Holstein Campus Kiel, Kiel; Wolfgang Bethge, University Hospital Tübingen, Tübingen; Guido Kobbe, Heinrich Heine University, Düsseldorf, Germany; Simona Iacobelli, Università Tor Vergata, Rome; Giorgio Lambertenghi Deliliers and Francesco Onida, Fondazione IRCC Ca' Granda Ospedale Maggiore Policlinico, University of Milano, Milan; Massimo Pini, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria; Stefano Guidi, Azienda Ospedaliera Universitaria Careggi, Florence, Italy; Ruzena Uddin, Guy's Hospital, London, United Kingdom; Marie Robin, Hôpital Saint Louis, Assistance Publique Hôpitaux Paris, France; Boris Afanasyev, SPB Pavlov Medical University, St Petersburg, Russia; Dominik Heim, University Hospital Basel, Basel Switzerland; Liisa Volin, Helsinki University Hospital, Helsiniki, Finland; Xavier Poiré, Cliniques Universitaires St-Luc, Brussels, Belgium; Marleen van Os, European Group of Blood and Marrow Transplantation Clinical Trials Office; Ronald Brand, Leiden University Medical Center, Leiden; and Theo de Witte, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Georg-Nikolaus Franke
- Nicolaus Kröger, University Medical Center Hamburg-Eppendorf, Hamburg; Georg-Nikolaus Franke, University Hospital Leipzig, Leipzig; Uwe Platzbecker, University Hospital Dresden, Dresden; Kai Hübel and Christof Scheid, University of Cologne, Cologne; Thomas Weber, University Hospital Halle (Saale), Martin-Luther-University Halle-Wittenberg, Halle; Matthias Stelljes, University of Münster, Münster; Peter Dreger, University of Heidelberg, Heidelberg; Andreas Günther, University Hospital Schleswig Holstein Campus Kiel, Kiel; Wolfgang Bethge, University Hospital Tübingen, Tübingen; Guido Kobbe, Heinrich Heine University, Düsseldorf, Germany; Simona Iacobelli, Università Tor Vergata, Rome; Giorgio Lambertenghi Deliliers and Francesco Onida, Fondazione IRCC Ca' Granda Ospedale Maggiore Policlinico, University of Milano, Milan; Massimo Pini, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria; Stefano Guidi, Azienda Ospedaliera Universitaria Careggi, Florence, Italy; Ruzena Uddin, Guy's Hospital, London, United Kingdom; Marie Robin, Hôpital Saint Louis, Assistance Publique Hôpitaux Paris, France; Boris Afanasyev, SPB Pavlov Medical University, St Petersburg, Russia; Dominik Heim, University Hospital Basel, Basel Switzerland; Liisa Volin, Helsinki University Hospital, Helsiniki, Finland; Xavier Poiré, Cliniques Universitaires St-Luc, Brussels, Belgium; Marleen van Os, European Group of Blood and Marrow Transplantation Clinical Trials Office; Ronald Brand, Leiden University Medical Center, Leiden; and Theo de Witte, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Uwe Platzbecker
- Nicolaus Kröger, University Medical Center Hamburg-Eppendorf, Hamburg; Georg-Nikolaus Franke, University Hospital Leipzig, Leipzig; Uwe Platzbecker, University Hospital Dresden, Dresden; Kai Hübel and Christof Scheid, University of Cologne, Cologne; Thomas Weber, University Hospital Halle (Saale), Martin-Luther-University Halle-Wittenberg, Halle; Matthias Stelljes, University of Münster, Münster; Peter Dreger, University of Heidelberg, Heidelberg; Andreas Günther, University Hospital Schleswig Holstein Campus Kiel, Kiel; Wolfgang Bethge, University Hospital Tübingen, Tübingen; Guido Kobbe, Heinrich Heine University, Düsseldorf, Germany; Simona Iacobelli, Università Tor Vergata, Rome; Giorgio Lambertenghi Deliliers and Francesco Onida, Fondazione IRCC Ca' Granda Ospedale Maggiore Policlinico, University of Milano, Milan; Massimo Pini, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria; Stefano Guidi, Azienda Ospedaliera Universitaria Careggi, Florence, Italy; Ruzena Uddin, Guy's Hospital, London, United Kingdom; Marie Robin, Hôpital Saint Louis, Assistance Publique Hôpitaux Paris, France; Boris Afanasyev, SPB Pavlov Medical University, St Petersburg, Russia; Dominik Heim, University Hospital Basel, Basel Switzerland; Liisa Volin, Helsinki University Hospital, Helsiniki, Finland; Xavier Poiré, Cliniques Universitaires St-Luc, Brussels, Belgium; Marleen van Os, European Group of Blood and Marrow Transplantation Clinical Trials Office; Ronald Brand, Leiden University Medical Center, Leiden; and Theo de Witte, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Ruzena Uddin
- Nicolaus Kröger, University Medical Center Hamburg-Eppendorf, Hamburg; Georg-Nikolaus Franke, University Hospital Leipzig, Leipzig; Uwe Platzbecker, University Hospital Dresden, Dresden; Kai Hübel and Christof Scheid, University of Cologne, Cologne; Thomas Weber, University Hospital Halle (Saale), Martin-Luther-University Halle-Wittenberg, Halle; Matthias Stelljes, University of Münster, Münster; Peter Dreger, University of Heidelberg, Heidelberg; Andreas Günther, University Hospital Schleswig Holstein Campus Kiel, Kiel; Wolfgang Bethge, University Hospital Tübingen, Tübingen; Guido Kobbe, Heinrich Heine University, Düsseldorf, Germany; Simona Iacobelli, Università Tor Vergata, Rome; Giorgio Lambertenghi Deliliers and Francesco Onida, Fondazione IRCC Ca' Granda Ospedale Maggiore Policlinico, University of Milano, Milan; Massimo Pini, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria; Stefano Guidi, Azienda Ospedaliera Universitaria Careggi, Florence, Italy; Ruzena Uddin, Guy's Hospital, London, United Kingdom; Marie Robin, Hôpital Saint Louis, Assistance Publique Hôpitaux Paris, France; Boris Afanasyev, SPB Pavlov Medical University, St Petersburg, Russia; Dominik Heim, University Hospital Basel, Basel Switzerland; Liisa Volin, Helsinki University Hospital, Helsiniki, Finland; Xavier Poiré, Cliniques Universitaires St-Luc, Brussels, Belgium; Marleen van Os, European Group of Blood and Marrow Transplantation Clinical Trials Office; Ronald Brand, Leiden University Medical Center, Leiden; and Theo de Witte, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Kai Hübel
- Nicolaus Kröger, University Medical Center Hamburg-Eppendorf, Hamburg; Georg-Nikolaus Franke, University Hospital Leipzig, Leipzig; Uwe Platzbecker, University Hospital Dresden, Dresden; Kai Hübel and Christof Scheid, University of Cologne, Cologne; Thomas Weber, University Hospital Halle (Saale), Martin-Luther-University Halle-Wittenberg, Halle; Matthias Stelljes, University of Münster, Münster; Peter Dreger, University of Heidelberg, Heidelberg; Andreas Günther, University Hospital Schleswig Holstein Campus Kiel, Kiel; Wolfgang Bethge, University Hospital Tübingen, Tübingen; Guido Kobbe, Heinrich Heine University, Düsseldorf, Germany; Simona Iacobelli, Università Tor Vergata, Rome; Giorgio Lambertenghi Deliliers and Francesco Onida, Fondazione IRCC Ca' Granda Ospedale Maggiore Policlinico, University of Milano, Milan; Massimo Pini, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria; Stefano Guidi, Azienda Ospedaliera Universitaria Careggi, Florence, Italy; Ruzena Uddin, Guy's Hospital, London, United Kingdom; Marie Robin, Hôpital Saint Louis, Assistance Publique Hôpitaux Paris, France; Boris Afanasyev, SPB Pavlov Medical University, St Petersburg, Russia; Dominik Heim, University Hospital Basel, Basel Switzerland; Liisa Volin, Helsinki University Hospital, Helsiniki, Finland; Xavier Poiré, Cliniques Universitaires St-Luc, Brussels, Belgium; Marleen van Os, European Group of Blood and Marrow Transplantation Clinical Trials Office; Ronald Brand, Leiden University Medical Center, Leiden; and Theo de Witte, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Christof Scheid
- Nicolaus Kröger, University Medical Center Hamburg-Eppendorf, Hamburg; Georg-Nikolaus Franke, University Hospital Leipzig, Leipzig; Uwe Platzbecker, University Hospital Dresden, Dresden; Kai Hübel and Christof Scheid, University of Cologne, Cologne; Thomas Weber, University Hospital Halle (Saale), Martin-Luther-University Halle-Wittenberg, Halle; Matthias Stelljes, University of Münster, Münster; Peter Dreger, University of Heidelberg, Heidelberg; Andreas Günther, University Hospital Schleswig Holstein Campus Kiel, Kiel; Wolfgang Bethge, University Hospital Tübingen, Tübingen; Guido Kobbe, Heinrich Heine University, Düsseldorf, Germany; Simona Iacobelli, Università Tor Vergata, Rome; Giorgio Lambertenghi Deliliers and Francesco Onida, Fondazione IRCC Ca' Granda Ospedale Maggiore Policlinico, University of Milano, Milan; Massimo Pini, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria; Stefano Guidi, Azienda Ospedaliera Universitaria Careggi, Florence, Italy; Ruzena Uddin, Guy's Hospital, London, United Kingdom; Marie Robin, Hôpital Saint Louis, Assistance Publique Hôpitaux Paris, France; Boris Afanasyev, SPB Pavlov Medical University, St Petersburg, Russia; Dominik Heim, University Hospital Basel, Basel Switzerland; Liisa Volin, Helsinki University Hospital, Helsiniki, Finland; Xavier Poiré, Cliniques Universitaires St-Luc, Brussels, Belgium; Marleen van Os, European Group of Blood and Marrow Transplantation Clinical Trials Office; Ronald Brand, Leiden University Medical Center, Leiden; and Theo de Witte, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Thomas Weber
- Nicolaus Kröger, University Medical Center Hamburg-Eppendorf, Hamburg; Georg-Nikolaus Franke, University Hospital Leipzig, Leipzig; Uwe Platzbecker, University Hospital Dresden, Dresden; Kai Hübel and Christof Scheid, University of Cologne, Cologne; Thomas Weber, University Hospital Halle (Saale), Martin-Luther-University Halle-Wittenberg, Halle; Matthias Stelljes, University of Münster, Münster; Peter Dreger, University of Heidelberg, Heidelberg; Andreas Günther, University Hospital Schleswig Holstein Campus Kiel, Kiel; Wolfgang Bethge, University Hospital Tübingen, Tübingen; Guido Kobbe, Heinrich Heine University, Düsseldorf, Germany; Simona Iacobelli, Università Tor Vergata, Rome; Giorgio Lambertenghi Deliliers and Francesco Onida, Fondazione IRCC Ca' Granda Ospedale Maggiore Policlinico, University of Milano, Milan; Massimo Pini, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria; Stefano Guidi, Azienda Ospedaliera Universitaria Careggi, Florence, Italy; Ruzena Uddin, Guy's Hospital, London, United Kingdom; Marie Robin, Hôpital Saint Louis, Assistance Publique Hôpitaux Paris, France; Boris Afanasyev, SPB Pavlov Medical University, St Petersburg, Russia; Dominik Heim, University Hospital Basel, Basel Switzerland; Liisa Volin, Helsinki University Hospital, Helsiniki, Finland; Xavier Poiré, Cliniques Universitaires St-Luc, Brussels, Belgium; Marleen van Os, European Group of Blood and Marrow Transplantation Clinical Trials Office; Ronald Brand, Leiden University Medical Center, Leiden; and Theo de Witte, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Marie Robin
- Nicolaus Kröger, University Medical Center Hamburg-Eppendorf, Hamburg; Georg-Nikolaus Franke, University Hospital Leipzig, Leipzig; Uwe Platzbecker, University Hospital Dresden, Dresden; Kai Hübel and Christof Scheid, University of Cologne, Cologne; Thomas Weber, University Hospital Halle (Saale), Martin-Luther-University Halle-Wittenberg, Halle; Matthias Stelljes, University of Münster, Münster; Peter Dreger, University of Heidelberg, Heidelberg; Andreas Günther, University Hospital Schleswig Holstein Campus Kiel, Kiel; Wolfgang Bethge, University Hospital Tübingen, Tübingen; Guido Kobbe, Heinrich Heine University, Düsseldorf, Germany; Simona Iacobelli, Università Tor Vergata, Rome; Giorgio Lambertenghi Deliliers and Francesco Onida, Fondazione IRCC Ca' Granda Ospedale Maggiore Policlinico, University of Milano, Milan; Massimo Pini, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria; Stefano Guidi, Azienda Ospedaliera Universitaria Careggi, Florence, Italy; Ruzena Uddin, Guy's Hospital, London, United Kingdom; Marie Robin, Hôpital Saint Louis, Assistance Publique Hôpitaux Paris, France; Boris Afanasyev, SPB Pavlov Medical University, St Petersburg, Russia; Dominik Heim, University Hospital Basel, Basel Switzerland; Liisa Volin, Helsinki University Hospital, Helsiniki, Finland; Xavier Poiré, Cliniques Universitaires St-Luc, Brussels, Belgium; Marleen van Os, European Group of Blood and Marrow Transplantation Clinical Trials Office; Ronald Brand, Leiden University Medical Center, Leiden; and Theo de Witte, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Matthias Stelljes
- Nicolaus Kröger, University Medical Center Hamburg-Eppendorf, Hamburg; Georg-Nikolaus Franke, University Hospital Leipzig, Leipzig; Uwe Platzbecker, University Hospital Dresden, Dresden; Kai Hübel and Christof Scheid, University of Cologne, Cologne; Thomas Weber, University Hospital Halle (Saale), Martin-Luther-University Halle-Wittenberg, Halle; Matthias Stelljes, University of Münster, Münster; Peter Dreger, University of Heidelberg, Heidelberg; Andreas Günther, University Hospital Schleswig Holstein Campus Kiel, Kiel; Wolfgang Bethge, University Hospital Tübingen, Tübingen; Guido Kobbe, Heinrich Heine University, Düsseldorf, Germany; Simona Iacobelli, Università Tor Vergata, Rome; Giorgio Lambertenghi Deliliers and Francesco Onida, Fondazione IRCC Ca' Granda Ospedale Maggiore Policlinico, University of Milano, Milan; Massimo Pini, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria; Stefano Guidi, Azienda Ospedaliera Universitaria Careggi, Florence, Italy; Ruzena Uddin, Guy's Hospital, London, United Kingdom; Marie Robin, Hôpital Saint Louis, Assistance Publique Hôpitaux Paris, France; Boris Afanasyev, SPB Pavlov Medical University, St Petersburg, Russia; Dominik Heim, University Hospital Basel, Basel Switzerland; Liisa Volin, Helsinki University Hospital, Helsiniki, Finland; Xavier Poiré, Cliniques Universitaires St-Luc, Brussels, Belgium; Marleen van Os, European Group of Blood and Marrow Transplantation Clinical Trials Office; Ronald Brand, Leiden University Medical Center, Leiden; and Theo de Witte, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Boris Afanasyev
- Nicolaus Kröger, University Medical Center Hamburg-Eppendorf, Hamburg; Georg-Nikolaus Franke, University Hospital Leipzig, Leipzig; Uwe Platzbecker, University Hospital Dresden, Dresden; Kai Hübel and Christof Scheid, University of Cologne, Cologne; Thomas Weber, University Hospital Halle (Saale), Martin-Luther-University Halle-Wittenberg, Halle; Matthias Stelljes, University of Münster, Münster; Peter Dreger, University of Heidelberg, Heidelberg; Andreas Günther, University Hospital Schleswig Holstein Campus Kiel, Kiel; Wolfgang Bethge, University Hospital Tübingen, Tübingen; Guido Kobbe, Heinrich Heine University, Düsseldorf, Germany; Simona Iacobelli, Università Tor Vergata, Rome; Giorgio Lambertenghi Deliliers and Francesco Onida, Fondazione IRCC Ca' Granda Ospedale Maggiore Policlinico, University of Milano, Milan; Massimo Pini, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria; Stefano Guidi, Azienda Ospedaliera Universitaria Careggi, Florence, Italy; Ruzena Uddin, Guy's Hospital, London, United Kingdom; Marie Robin, Hôpital Saint Louis, Assistance Publique Hôpitaux Paris, France; Boris Afanasyev, SPB Pavlov Medical University, St Petersburg, Russia; Dominik Heim, University Hospital Basel, Basel Switzerland; Liisa Volin, Helsinki University Hospital, Helsiniki, Finland; Xavier Poiré, Cliniques Universitaires St-Luc, Brussels, Belgium; Marleen van Os, European Group of Blood and Marrow Transplantation Clinical Trials Office; Ronald Brand, Leiden University Medical Center, Leiden; and Theo de Witte, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Dominik Heim
- Nicolaus Kröger, University Medical Center Hamburg-Eppendorf, Hamburg; Georg-Nikolaus Franke, University Hospital Leipzig, Leipzig; Uwe Platzbecker, University Hospital Dresden, Dresden; Kai Hübel and Christof Scheid, University of Cologne, Cologne; Thomas Weber, University Hospital Halle (Saale), Martin-Luther-University Halle-Wittenberg, Halle; Matthias Stelljes, University of Münster, Münster; Peter Dreger, University of Heidelberg, Heidelberg; Andreas Günther, University Hospital Schleswig Holstein Campus Kiel, Kiel; Wolfgang Bethge, University Hospital Tübingen, Tübingen; Guido Kobbe, Heinrich Heine University, Düsseldorf, Germany; Simona Iacobelli, Università Tor Vergata, Rome; Giorgio Lambertenghi Deliliers and Francesco Onida, Fondazione IRCC Ca' Granda Ospedale Maggiore Policlinico, University of Milano, Milan; Massimo Pini, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria; Stefano Guidi, Azienda Ospedaliera Universitaria Careggi, Florence, Italy; Ruzena Uddin, Guy's Hospital, London, United Kingdom; Marie Robin, Hôpital Saint Louis, Assistance Publique Hôpitaux Paris, France; Boris Afanasyev, SPB Pavlov Medical University, St Petersburg, Russia; Dominik Heim, University Hospital Basel, Basel Switzerland; Liisa Volin, Helsinki University Hospital, Helsiniki, Finland; Xavier Poiré, Cliniques Universitaires St-Luc, Brussels, Belgium; Marleen van Os, European Group of Blood and Marrow Transplantation Clinical Trials Office; Ronald Brand, Leiden University Medical Center, Leiden; and Theo de Witte, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Giorgio Lambertenghi Deliliers
- Nicolaus Kröger, University Medical Center Hamburg-Eppendorf, Hamburg; Georg-Nikolaus Franke, University Hospital Leipzig, Leipzig; Uwe Platzbecker, University Hospital Dresden, Dresden; Kai Hübel and Christof Scheid, University of Cologne, Cologne; Thomas Weber, University Hospital Halle (Saale), Martin-Luther-University Halle-Wittenberg, Halle; Matthias Stelljes, University of Münster, Münster; Peter Dreger, University of Heidelberg, Heidelberg; Andreas Günther, University Hospital Schleswig Holstein Campus Kiel, Kiel; Wolfgang Bethge, University Hospital Tübingen, Tübingen; Guido Kobbe, Heinrich Heine University, Düsseldorf, Germany; Simona Iacobelli, Università Tor Vergata, Rome; Giorgio Lambertenghi Deliliers and Francesco Onida, Fondazione IRCC Ca' Granda Ospedale Maggiore Policlinico, University of Milano, Milan; Massimo Pini, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria; Stefano Guidi, Azienda Ospedaliera Universitaria Careggi, Florence, Italy; Ruzena Uddin, Guy's Hospital, London, United Kingdom; Marie Robin, Hôpital Saint Louis, Assistance Publique Hôpitaux Paris, France; Boris Afanasyev, SPB Pavlov Medical University, St Petersburg, Russia; Dominik Heim, University Hospital Basel, Basel Switzerland; Liisa Volin, Helsinki University Hospital, Helsiniki, Finland; Xavier Poiré, Cliniques Universitaires St-Luc, Brussels, Belgium; Marleen van Os, European Group of Blood and Marrow Transplantation Clinical Trials Office; Ronald Brand, Leiden University Medical Center, Leiden; and Theo de Witte, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Francesco Onida
- Nicolaus Kröger, University Medical Center Hamburg-Eppendorf, Hamburg; Georg-Nikolaus Franke, University Hospital Leipzig, Leipzig; Uwe Platzbecker, University Hospital Dresden, Dresden; Kai Hübel and Christof Scheid, University of Cologne, Cologne; Thomas Weber, University Hospital Halle (Saale), Martin-Luther-University Halle-Wittenberg, Halle; Matthias Stelljes, University of Münster, Münster; Peter Dreger, University of Heidelberg, Heidelberg; Andreas Günther, University Hospital Schleswig Holstein Campus Kiel, Kiel; Wolfgang Bethge, University Hospital Tübingen, Tübingen; Guido Kobbe, Heinrich Heine University, Düsseldorf, Germany; Simona Iacobelli, Università Tor Vergata, Rome; Giorgio Lambertenghi Deliliers and Francesco Onida, Fondazione IRCC Ca' Granda Ospedale Maggiore Policlinico, University of Milano, Milan; Massimo Pini, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria; Stefano Guidi, Azienda Ospedaliera Universitaria Careggi, Florence, Italy; Ruzena Uddin, Guy's Hospital, London, United Kingdom; Marie Robin, Hôpital Saint Louis, Assistance Publique Hôpitaux Paris, France; Boris Afanasyev, SPB Pavlov Medical University, St Petersburg, Russia; Dominik Heim, University Hospital Basel, Basel Switzerland; Liisa Volin, Helsinki University Hospital, Helsiniki, Finland; Xavier Poiré, Cliniques Universitaires St-Luc, Brussels, Belgium; Marleen van Os, European Group of Blood and Marrow Transplantation Clinical Trials Office; Ronald Brand, Leiden University Medical Center, Leiden; and Theo de Witte, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Peter Dreger
- Nicolaus Kröger, University Medical Center Hamburg-Eppendorf, Hamburg; Georg-Nikolaus Franke, University Hospital Leipzig, Leipzig; Uwe Platzbecker, University Hospital Dresden, Dresden; Kai Hübel and Christof Scheid, University of Cologne, Cologne; Thomas Weber, University Hospital Halle (Saale), Martin-Luther-University Halle-Wittenberg, Halle; Matthias Stelljes, University of Münster, Münster; Peter Dreger, University of Heidelberg, Heidelberg; Andreas Günther, University Hospital Schleswig Holstein Campus Kiel, Kiel; Wolfgang Bethge, University Hospital Tübingen, Tübingen; Guido Kobbe, Heinrich Heine University, Düsseldorf, Germany; Simona Iacobelli, Università Tor Vergata, Rome; Giorgio Lambertenghi Deliliers and Francesco Onida, Fondazione IRCC Ca' Granda Ospedale Maggiore Policlinico, University of Milano, Milan; Massimo Pini, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria; Stefano Guidi, Azienda Ospedaliera Universitaria Careggi, Florence, Italy; Ruzena Uddin, Guy's Hospital, London, United Kingdom; Marie Robin, Hôpital Saint Louis, Assistance Publique Hôpitaux Paris, France; Boris Afanasyev, SPB Pavlov Medical University, St Petersburg, Russia; Dominik Heim, University Hospital Basel, Basel Switzerland; Liisa Volin, Helsinki University Hospital, Helsiniki, Finland; Xavier Poiré, Cliniques Universitaires St-Luc, Brussels, Belgium; Marleen van Os, European Group of Blood and Marrow Transplantation Clinical Trials Office; Ronald Brand, Leiden University Medical Center, Leiden; and Theo de Witte, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Massimo Pini
- Nicolaus Kröger, University Medical Center Hamburg-Eppendorf, Hamburg; Georg-Nikolaus Franke, University Hospital Leipzig, Leipzig; Uwe Platzbecker, University Hospital Dresden, Dresden; Kai Hübel and Christof Scheid, University of Cologne, Cologne; Thomas Weber, University Hospital Halle (Saale), Martin-Luther-University Halle-Wittenberg, Halle; Matthias Stelljes, University of Münster, Münster; Peter Dreger, University of Heidelberg, Heidelberg; Andreas Günther, University Hospital Schleswig Holstein Campus Kiel, Kiel; Wolfgang Bethge, University Hospital Tübingen, Tübingen; Guido Kobbe, Heinrich Heine University, Düsseldorf, Germany; Simona Iacobelli, Università Tor Vergata, Rome; Giorgio Lambertenghi Deliliers and Francesco Onida, Fondazione IRCC Ca' Granda Ospedale Maggiore Policlinico, University of Milano, Milan; Massimo Pini, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria; Stefano Guidi, Azienda Ospedaliera Universitaria Careggi, Florence, Italy; Ruzena Uddin, Guy's Hospital, London, United Kingdom; Marie Robin, Hôpital Saint Louis, Assistance Publique Hôpitaux Paris, France; Boris Afanasyev, SPB Pavlov Medical University, St Petersburg, Russia; Dominik Heim, University Hospital Basel, Basel Switzerland; Liisa Volin, Helsinki University Hospital, Helsiniki, Finland; Xavier Poiré, Cliniques Universitaires St-Luc, Brussels, Belgium; Marleen van Os, European Group of Blood and Marrow Transplantation Clinical Trials Office; Ronald Brand, Leiden University Medical Center, Leiden; and Theo de Witte, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Stefano Guidi
- Nicolaus Kröger, University Medical Center Hamburg-Eppendorf, Hamburg; Georg-Nikolaus Franke, University Hospital Leipzig, Leipzig; Uwe Platzbecker, University Hospital Dresden, Dresden; Kai Hübel and Christof Scheid, University of Cologne, Cologne; Thomas Weber, University Hospital Halle (Saale), Martin-Luther-University Halle-Wittenberg, Halle; Matthias Stelljes, University of Münster, Münster; Peter Dreger, University of Heidelberg, Heidelberg; Andreas Günther, University Hospital Schleswig Holstein Campus Kiel, Kiel; Wolfgang Bethge, University Hospital Tübingen, Tübingen; Guido Kobbe, Heinrich Heine University, Düsseldorf, Germany; Simona Iacobelli, Università Tor Vergata, Rome; Giorgio Lambertenghi Deliliers and Francesco Onida, Fondazione IRCC Ca' Granda Ospedale Maggiore Policlinico, University of Milano, Milan; Massimo Pini, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria; Stefano Guidi, Azienda Ospedaliera Universitaria Careggi, Florence, Italy; Ruzena Uddin, Guy's Hospital, London, United Kingdom; Marie Robin, Hôpital Saint Louis, Assistance Publique Hôpitaux Paris, France; Boris Afanasyev, SPB Pavlov Medical University, St Petersburg, Russia; Dominik Heim, University Hospital Basel, Basel Switzerland; Liisa Volin, Helsinki University Hospital, Helsiniki, Finland; Xavier Poiré, Cliniques Universitaires St-Luc, Brussels, Belgium; Marleen van Os, European Group of Blood and Marrow Transplantation Clinical Trials Office; Ronald Brand, Leiden University Medical Center, Leiden; and Theo de Witte, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Liisa Volin
- Nicolaus Kröger, University Medical Center Hamburg-Eppendorf, Hamburg; Georg-Nikolaus Franke, University Hospital Leipzig, Leipzig; Uwe Platzbecker, University Hospital Dresden, Dresden; Kai Hübel and Christof Scheid, University of Cologne, Cologne; Thomas Weber, University Hospital Halle (Saale), Martin-Luther-University Halle-Wittenberg, Halle; Matthias Stelljes, University of Münster, Münster; Peter Dreger, University of Heidelberg, Heidelberg; Andreas Günther, University Hospital Schleswig Holstein Campus Kiel, Kiel; Wolfgang Bethge, University Hospital Tübingen, Tübingen; Guido Kobbe, Heinrich Heine University, Düsseldorf, Germany; Simona Iacobelli, Università Tor Vergata, Rome; Giorgio Lambertenghi Deliliers and Francesco Onida, Fondazione IRCC Ca' Granda Ospedale Maggiore Policlinico, University of Milano, Milan; Massimo Pini, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria; Stefano Guidi, Azienda Ospedaliera Universitaria Careggi, Florence, Italy; Ruzena Uddin, Guy's Hospital, London, United Kingdom; Marie Robin, Hôpital Saint Louis, Assistance Publique Hôpitaux Paris, France; Boris Afanasyev, SPB Pavlov Medical University, St Petersburg, Russia; Dominik Heim, University Hospital Basel, Basel Switzerland; Liisa Volin, Helsinki University Hospital, Helsiniki, Finland; Xavier Poiré, Cliniques Universitaires St-Luc, Brussels, Belgium; Marleen van Os, European Group of Blood and Marrow Transplantation Clinical Trials Office; Ronald Brand, Leiden University Medical Center, Leiden; and Theo de Witte, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Andreas Günther
- Nicolaus Kröger, University Medical Center Hamburg-Eppendorf, Hamburg; Georg-Nikolaus Franke, University Hospital Leipzig, Leipzig; Uwe Platzbecker, University Hospital Dresden, Dresden; Kai Hübel and Christof Scheid, University of Cologne, Cologne; Thomas Weber, University Hospital Halle (Saale), Martin-Luther-University Halle-Wittenberg, Halle; Matthias Stelljes, University of Münster, Münster; Peter Dreger, University of Heidelberg, Heidelberg; Andreas Günther, University Hospital Schleswig Holstein Campus Kiel, Kiel; Wolfgang Bethge, University Hospital Tübingen, Tübingen; Guido Kobbe, Heinrich Heine University, Düsseldorf, Germany; Simona Iacobelli, Università Tor Vergata, Rome; Giorgio Lambertenghi Deliliers and Francesco Onida, Fondazione IRCC Ca' Granda Ospedale Maggiore Policlinico, University of Milano, Milan; Massimo Pini, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria; Stefano Guidi, Azienda Ospedaliera Universitaria Careggi, Florence, Italy; Ruzena Uddin, Guy's Hospital, London, United Kingdom; Marie Robin, Hôpital Saint Louis, Assistance Publique Hôpitaux Paris, France; Boris Afanasyev, SPB Pavlov Medical University, St Petersburg, Russia; Dominik Heim, University Hospital Basel, Basel Switzerland; Liisa Volin, Helsinki University Hospital, Helsiniki, Finland; Xavier Poiré, Cliniques Universitaires St-Luc, Brussels, Belgium; Marleen van Os, European Group of Blood and Marrow Transplantation Clinical Trials Office; Ronald Brand, Leiden University Medical Center, Leiden; and Theo de Witte, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Wolfgang Bethge
- Nicolaus Kröger, University Medical Center Hamburg-Eppendorf, Hamburg; Georg-Nikolaus Franke, University Hospital Leipzig, Leipzig; Uwe Platzbecker, University Hospital Dresden, Dresden; Kai Hübel and Christof Scheid, University of Cologne, Cologne; Thomas Weber, University Hospital Halle (Saale), Martin-Luther-University Halle-Wittenberg, Halle; Matthias Stelljes, University of Münster, Münster; Peter Dreger, University of Heidelberg, Heidelberg; Andreas Günther, University Hospital Schleswig Holstein Campus Kiel, Kiel; Wolfgang Bethge, University Hospital Tübingen, Tübingen; Guido Kobbe, Heinrich Heine University, Düsseldorf, Germany; Simona Iacobelli, Università Tor Vergata, Rome; Giorgio Lambertenghi Deliliers and Francesco Onida, Fondazione IRCC Ca' Granda Ospedale Maggiore Policlinico, University of Milano, Milan; Massimo Pini, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria; Stefano Guidi, Azienda Ospedaliera Universitaria Careggi, Florence, Italy; Ruzena Uddin, Guy's Hospital, London, United Kingdom; Marie Robin, Hôpital Saint Louis, Assistance Publique Hôpitaux Paris, France; Boris Afanasyev, SPB Pavlov Medical University, St Petersburg, Russia; Dominik Heim, University Hospital Basel, Basel Switzerland; Liisa Volin, Helsinki University Hospital, Helsiniki, Finland; Xavier Poiré, Cliniques Universitaires St-Luc, Brussels, Belgium; Marleen van Os, European Group of Blood and Marrow Transplantation Clinical Trials Office; Ronald Brand, Leiden University Medical Center, Leiden; and Theo de Witte, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Xavier Poiré
- Nicolaus Kröger, University Medical Center Hamburg-Eppendorf, Hamburg; Georg-Nikolaus Franke, University Hospital Leipzig, Leipzig; Uwe Platzbecker, University Hospital Dresden, Dresden; Kai Hübel and Christof Scheid, University of Cologne, Cologne; Thomas Weber, University Hospital Halle (Saale), Martin-Luther-University Halle-Wittenberg, Halle; Matthias Stelljes, University of Münster, Münster; Peter Dreger, University of Heidelberg, Heidelberg; Andreas Günther, University Hospital Schleswig Holstein Campus Kiel, Kiel; Wolfgang Bethge, University Hospital Tübingen, Tübingen; Guido Kobbe, Heinrich Heine University, Düsseldorf, Germany; Simona Iacobelli, Università Tor Vergata, Rome; Giorgio Lambertenghi Deliliers and Francesco Onida, Fondazione IRCC Ca' Granda Ospedale Maggiore Policlinico, University of Milano, Milan; Massimo Pini, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria; Stefano Guidi, Azienda Ospedaliera Universitaria Careggi, Florence, Italy; Ruzena Uddin, Guy's Hospital, London, United Kingdom; Marie Robin, Hôpital Saint Louis, Assistance Publique Hôpitaux Paris, France; Boris Afanasyev, SPB Pavlov Medical University, St Petersburg, Russia; Dominik Heim, University Hospital Basel, Basel Switzerland; Liisa Volin, Helsinki University Hospital, Helsiniki, Finland; Xavier Poiré, Cliniques Universitaires St-Luc, Brussels, Belgium; Marleen van Os, European Group of Blood and Marrow Transplantation Clinical Trials Office; Ronald Brand, Leiden University Medical Center, Leiden; and Theo de Witte, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Guido Kobbe
- Nicolaus Kröger, University Medical Center Hamburg-Eppendorf, Hamburg; Georg-Nikolaus Franke, University Hospital Leipzig, Leipzig; Uwe Platzbecker, University Hospital Dresden, Dresden; Kai Hübel and Christof Scheid, University of Cologne, Cologne; Thomas Weber, University Hospital Halle (Saale), Martin-Luther-University Halle-Wittenberg, Halle; Matthias Stelljes, University of Münster, Münster; Peter Dreger, University of Heidelberg, Heidelberg; Andreas Günther, University Hospital Schleswig Holstein Campus Kiel, Kiel; Wolfgang Bethge, University Hospital Tübingen, Tübingen; Guido Kobbe, Heinrich Heine University, Düsseldorf, Germany; Simona Iacobelli, Università Tor Vergata, Rome; Giorgio Lambertenghi Deliliers and Francesco Onida, Fondazione IRCC Ca' Granda Ospedale Maggiore Policlinico, University of Milano, Milan; Massimo Pini, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria; Stefano Guidi, Azienda Ospedaliera Universitaria Careggi, Florence, Italy; Ruzena Uddin, Guy's Hospital, London, United Kingdom; Marie Robin, Hôpital Saint Louis, Assistance Publique Hôpitaux Paris, France; Boris Afanasyev, SPB Pavlov Medical University, St Petersburg, Russia; Dominik Heim, University Hospital Basel, Basel Switzerland; Liisa Volin, Helsinki University Hospital, Helsiniki, Finland; Xavier Poiré, Cliniques Universitaires St-Luc, Brussels, Belgium; Marleen van Os, European Group of Blood and Marrow Transplantation Clinical Trials Office; Ronald Brand, Leiden University Medical Center, Leiden; and Theo de Witte, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Marleen van Os
- Nicolaus Kröger, University Medical Center Hamburg-Eppendorf, Hamburg; Georg-Nikolaus Franke, University Hospital Leipzig, Leipzig; Uwe Platzbecker, University Hospital Dresden, Dresden; Kai Hübel and Christof Scheid, University of Cologne, Cologne; Thomas Weber, University Hospital Halle (Saale), Martin-Luther-University Halle-Wittenberg, Halle; Matthias Stelljes, University of Münster, Münster; Peter Dreger, University of Heidelberg, Heidelberg; Andreas Günther, University Hospital Schleswig Holstein Campus Kiel, Kiel; Wolfgang Bethge, University Hospital Tübingen, Tübingen; Guido Kobbe, Heinrich Heine University, Düsseldorf, Germany; Simona Iacobelli, Università Tor Vergata, Rome; Giorgio Lambertenghi Deliliers and Francesco Onida, Fondazione IRCC Ca' Granda Ospedale Maggiore Policlinico, University of Milano, Milan; Massimo Pini, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria; Stefano Guidi, Azienda Ospedaliera Universitaria Careggi, Florence, Italy; Ruzena Uddin, Guy's Hospital, London, United Kingdom; Marie Robin, Hôpital Saint Louis, Assistance Publique Hôpitaux Paris, France; Boris Afanasyev, SPB Pavlov Medical University, St Petersburg, Russia; Dominik Heim, University Hospital Basel, Basel Switzerland; Liisa Volin, Helsinki University Hospital, Helsiniki, Finland; Xavier Poiré, Cliniques Universitaires St-Luc, Brussels, Belgium; Marleen van Os, European Group of Blood and Marrow Transplantation Clinical Trials Office; Ronald Brand, Leiden University Medical Center, Leiden; and Theo de Witte, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Ronald Brand
- Nicolaus Kröger, University Medical Center Hamburg-Eppendorf, Hamburg; Georg-Nikolaus Franke, University Hospital Leipzig, Leipzig; Uwe Platzbecker, University Hospital Dresden, Dresden; Kai Hübel and Christof Scheid, University of Cologne, Cologne; Thomas Weber, University Hospital Halle (Saale), Martin-Luther-University Halle-Wittenberg, Halle; Matthias Stelljes, University of Münster, Münster; Peter Dreger, University of Heidelberg, Heidelberg; Andreas Günther, University Hospital Schleswig Holstein Campus Kiel, Kiel; Wolfgang Bethge, University Hospital Tübingen, Tübingen; Guido Kobbe, Heinrich Heine University, Düsseldorf, Germany; Simona Iacobelli, Università Tor Vergata, Rome; Giorgio Lambertenghi Deliliers and Francesco Onida, Fondazione IRCC Ca' Granda Ospedale Maggiore Policlinico, University of Milano, Milan; Massimo Pini, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria; Stefano Guidi, Azienda Ospedaliera Universitaria Careggi, Florence, Italy; Ruzena Uddin, Guy's Hospital, London, United Kingdom; Marie Robin, Hôpital Saint Louis, Assistance Publique Hôpitaux Paris, France; Boris Afanasyev, SPB Pavlov Medical University, St Petersburg, Russia; Dominik Heim, University Hospital Basel, Basel Switzerland; Liisa Volin, Helsinki University Hospital, Helsiniki, Finland; Xavier Poiré, Cliniques Universitaires St-Luc, Brussels, Belgium; Marleen van Os, European Group of Blood and Marrow Transplantation Clinical Trials Office; Ronald Brand, Leiden University Medical Center, Leiden; and Theo de Witte, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Theo de Witte
- Nicolaus Kröger, University Medical Center Hamburg-Eppendorf, Hamburg; Georg-Nikolaus Franke, University Hospital Leipzig, Leipzig; Uwe Platzbecker, University Hospital Dresden, Dresden; Kai Hübel and Christof Scheid, University of Cologne, Cologne; Thomas Weber, University Hospital Halle (Saale), Martin-Luther-University Halle-Wittenberg, Halle; Matthias Stelljes, University of Münster, Münster; Peter Dreger, University of Heidelberg, Heidelberg; Andreas Günther, University Hospital Schleswig Holstein Campus Kiel, Kiel; Wolfgang Bethge, University Hospital Tübingen, Tübingen; Guido Kobbe, Heinrich Heine University, Düsseldorf, Germany; Simona Iacobelli, Università Tor Vergata, Rome; Giorgio Lambertenghi Deliliers and Francesco Onida, Fondazione IRCC Ca' Granda Ospedale Maggiore Policlinico, University of Milano, Milan; Massimo Pini, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria; Stefano Guidi, Azienda Ospedaliera Universitaria Careggi, Florence, Italy; Ruzena Uddin, Guy's Hospital, London, United Kingdom; Marie Robin, Hôpital Saint Louis, Assistance Publique Hôpitaux Paris, France; Boris Afanasyev, SPB Pavlov Medical University, St Petersburg, Russia; Dominik Heim, University Hospital Basel, Basel Switzerland; Liisa Volin, Helsinki University Hospital, Helsiniki, Finland; Xavier Poiré, Cliniques Universitaires St-Luc, Brussels, Belgium; Marleen van Os, European Group of Blood and Marrow Transplantation Clinical Trials Office; Ronald Brand, Leiden University Medical Center, Leiden; and Theo de Witte, Radboud University Medical Center, Nijmegen, the Netherlands
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Mustafa Ali M, Abounader DM, Rybicki LA, Yurch MA, Starn J, Ferraro C, Winslow V, Hamilton BK, Gerds AT, Liu H, Dean R, Hill BT, Pohlman B, Andresen S, Hanna R, Kalaycio M, Bolwell BJ, Majhail NS, Sobecks RM. Comparative Effectiveness of Busulfan and Fludarabine versus Fludarabine and 400 cGy Total Body Irradiation Conditioning Regimens for Acute Myeloid Leukemia/Myelodysplastic Syndrome. Biol Blood Marrow Transplant 2017; 23:776-781. [DOI: 10.1016/j.bbmt.2017.01.077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 01/16/2017] [Indexed: 01/10/2023]
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Long-term follow-up of a retrospective comparison of reduced-intensity conditioning and conventional high-dose conditioning for allogeneic transplantation from matched related donors in myelodysplastic syndromes. Bone Marrow Transplant 2017; 52:1107-1112. [PMID: 28319072 DOI: 10.1038/bmt.2017.19] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 12/20/2016] [Accepted: 01/12/2017] [Indexed: 01/22/2023]
Abstract
This study shows the long-term updated outcomes of a multicenter retrospective study which analyzed 843 patients with myelodysplastic syndrome (MDS) who underwent transplantation with an HLA-identical sibling donor with either reduced-intensity conditioning (RIC) in 213 patients, or standard myeloablative conditioning (MAC) in 630 patients. In multivariate analysis, the 13-year relapse rate was significantly increased after RIC (31% after MAC vs 48% in RIC; HR, 1.5; 95% CI, 1.1-1.9; P=0.04), but with no differences in overall survival (OS) (30% after MAC vs 27% in RIC; P=0.4) and PFS (29 vs 21%, respectively, P=0.3). Non-relapse mortality was higher in MAC (40 vs 31%; P=0.1), especially in patients older than 50 years (50 vs 33%, P<0.01). In addition, long-term follow-up confirms the importance of other variables on 13-year OS, mainly MDS risk category, disease phase, cytogenetics and receiving a high donor cell dose, irrespective of the conditioning regimen used.
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Sakellari I, Mallouri D, Gavriilaki E, Batsis I, Kaliou M, Constantinou V, Papalexandri A, Lalayanni C, Vadikolia C, Athanasiadou A, Yannaki E, Sotiropoulos D, Smias C, Anagnostopoulos A. Survival Advantage and Comparable Toxicity in Reduced-Toxicity Treosulfan-Based versus Reduced-Intensity Busulfan-Based Conditioning Regimen in Myelodysplastic Syndrome and Acute Myeloid Leukemia Patients after Allogeneic Hematopoietic Cell Transplantation. Biol Blood Marrow Transplant 2017; 23:445-451. [DOI: 10.1016/j.bbmt.2016.11.023] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 11/29/2016] [Indexed: 12/28/2022]
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Reduced-intensity conditioning allogeneic hematopoietic cell transplantation for younger patients with acute myeloid leukemia: a registry-based study. Bone Marrow Transplant 2017; 52:818-824. [DOI: 10.1038/bmt.2016.358] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 12/01/2016] [Accepted: 12/06/2016] [Indexed: 12/31/2022]
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Allogeneic hematopoietic stem cell transplantation for MDS and CMML: recommendations from an international expert panel. Blood 2017; 129:1753-1762. [PMID: 28096091 DOI: 10.1182/blood-2016-06-724500] [Citation(s) in RCA: 223] [Impact Index Per Article: 31.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Accepted: 01/04/2017] [Indexed: 01/19/2023] Open
Abstract
An international expert panel, active within the European Society for Blood and Marrow Transplantation, European LeukemiaNet, Blood and Marrow Transplant Clinical Trial Group, and the International Myelodysplastic Syndromes Foundation developed recommendations for allogeneic hematopoietic stem cell transplantation (HSCT) in myelodysplastic syndromes (MDS) and chronic myelomonocytic leukemia (CMML). Disease risks scored according to the revised International Prognostic Scoring System (IPSS-R) and presence of comorbidity graded according to the HCT Comorbidity Index (HCT-CI) were recognized as relevant clinical variables for HSCT eligibility. Fit patients with higher-risk IPSS-R and those with lower-risk IPSS-R with poor-risk genetic features, profound cytopenias, and high transfusion burden are candidates for HSCT. Patients with a very high MDS transplantation risk score, based on combination of advanced age, high HCT-CI, very poor-risk cytogenetic and molecular features, and high IPSS-R score have a low chance of cure with standard HSCT and consideration should be given to treating these patients in investigational studies. Cytoreductive therapy prior to HSCT is advised for patients with ≥10% bone marrow myeloblasts. Evidence from prospective randomized clinical trials does not provide support for specific recommendations on the optimal high intensity conditioning regimen. For patients with contraindications to high-intensity preparative regimens, reduced intensity conditioning should be considered. Optimal timing of HSCT requires careful evaluation of the available effective nontransplant strategies. Prophylactic donor lymphocyte infusion (DLI) strategies are recommended in patients at high risk of relapse after HSCT. Immune modulation by DLI strategies or second HSCT is advised if relapse occurs beyond 6 months after HSCT.
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Diagnosis and management of AML in adults: 2017 ELN recommendations from an international expert panel. Blood 2016; 129:424-447. [PMID: 27895058 DOI: 10.1182/blood-2016-08-733196] [Citation(s) in RCA: 3878] [Impact Index Per Article: 484.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 11/15/2016] [Indexed: 12/13/2022] Open
Abstract
The first edition of the European LeukemiaNet (ELN) recommendations for diagnosis and management of acute myeloid leukemia (AML) in adults, published in 2010, has found broad acceptance by physicians and investigators caring for patients with AML. Recent advances, for example, in the discovery of the genomic landscape of the disease, in the development of assays for genetic testing and for detecting minimal residual disease (MRD), as well as in the development of novel antileukemic agents, prompted an international panel to provide updated evidence- and expert opinion-based recommendations. The recommendations include a revised version of the ELN genetic categories, a proposal for a response category based on MRD status, and criteria for progressive disease.
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Shimoni A, Labopin M, Savani B, Volin L, Ehninger G, Kuball J, Bunjes D, Schaap N, Vigouroux S, Bacigalupo A, Veelken H, Sierra J, Eder M, Niederwieser D, Mohty M, Nagler A. 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. J Hematol Oncol 2016; 9:118. [PMID: 27821187 PMCID: PMC5100212 DOI: 10.1186/s13045-016-0347-1] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 10/18/2016] [Indexed: 11/10/2022] Open
Abstract
Background 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. Methods 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). Results 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. Conclusions 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. Electronic supplementary material The online version of this article (doi:10.1186/s13045-016-0347-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Avichai Shimoni
- Department of Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel HaShomer and Tel-Aviv University, Tel Aviv, Israel.
| | - Myriam Labopin
- Hôpital Saint Antoine, ALWP office, Service d'Hématologie et de Thérapie cellulaire, Paris, France
| | - Bipin Savani
- Vanderbilt University Hematology and Transplantation, Nashville, USA
| | - Liisa Volin
- Stem Cell Transplantation Unit, HUCH Comprehensive Cancer Center, Helsinki, Finland
| | - Gerhard Ehninger
- Universitaetsklinikum Dresden, Medizinische Klinik und Poliklinik I, Dresden, Germany
| | - Jurgen Kuball
- Department of Haematology, University Medical Centre, Utrecht, The Netherlands
| | - Donald Bunjes
- Klinik fuer Innere Medzin III, Universitätsklinikum Ulm, Ulm, Germany
| | - Nicolaas Schaap
- Department of Hematology, Nijmegen Medical Centre, Nijmegen, The Netherlands
| | | | | | - Hendrik Veelken
- Leiden University Hospital, BMT Centre Leiden, Leiden, The Netherlands
| | - Jorge Sierra
- Hematology Department, IIB Sant Pau and Josep Carreras Leukemia Research Institutes, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - Matthias Eder
- Department of Haematology, Hemostasis, Oncology, and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Dietger Niederwieser
- University Hospital Leipzig, Division of Haematology and Oncology, Leipzig, Germany
| | - Mohamad Mohty
- Hôpital Saint Antoine, ALWP office, Service d'Hématologie et de Thérapie cellulaire, Paris, France
| | - Arnon Nagler
- 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
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Ossenkoppele GJ, Janssen JJWM, van de Loosdrecht AA. Risk factors for relapse after allogeneic transplantation in acute myeloid leukemia. Haematologica 2016; 101:20-5. [PMID: 26721801 DOI: 10.3324/haematol.2015.139105] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Acute myeloid leukemia is a clonal neoplasm derived from myeloid progenitor cells with a varying outcome. The initial goal of treatment is the achievement of complete remission, defined for over 40 years by morphology. However, without additional post-remission treatment the majority of patients relapse. In many cases of acute myeloid leukemia, allogeneic stem cell transplantation offers the best prospects of cure. In 2013, 5608 stem cell transplantations in acute myeloid leukemia were performed in Europe (5228 allogeneic and 380 autologous stem cell transplantations). Most stem cell transplantations are performed in first complete remission. However, despite a considerable reduction in the chance of relapse, in most studies, overall survival benefit of allogeneic stem cell transplantation is modest due to substantial non-relapse mortality. Here we discuss the many factors related to the risk of relapse after allogeneic stem cell transplantation.
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Cremers EMP, van Biezen A, de Wreede LC, Scholten M, Vitek A, Finke J, Platzbecker U, Beelen D, Schwerdtfeger R, Volin L, Harhalakis N, Blijlevens N, Nagler A, Kröger N, de Witte T. Prognostic pre-transplant factors in myelodysplastic syndromes primarily treated by high dose allogeneic hematopoietic stem cell transplantation: a retrospective study of the MDS subcommittee of the CMWP of the EBMT. Ann Hematol 2016; 95:1971-1978. [PMID: 27650829 PMCID: PMC5093200 DOI: 10.1007/s00277-016-2802-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 08/26/2016] [Indexed: 01/28/2023]
Abstract
Many pre-transplant factors are known to influence the outcome of allogeneic stem cell transplantation (SCT) treatment in myelodysplastic syndromes (MDS). However, patient cohorts are often heterogeneous by disease stage and treatment modalities, which complicates interpretation of the results. This study aimed to obtain a homogeneous patient cohort by including only de novo MDS patients who received upfront allogeneic SCT after standard high dose myelo-ablative conditioning. The effect of pre-transplant factors such as age, disease stage, transfusions, iron parameters and comorbidity on overall survival (OS), non-relapse mortality (NRM), and relapse incidence (RI) was evaluated in 201 patients. In this cohort, characterized by low comorbidity and a short interval between diagnosis and transplantation, NRM was the most determinant factor for survival after SCT (47 % after 2-year follow-up). WHO classification and transfusion burden were the only modalities with a significant impact on overall survival after SCT. Estimated hazard ratios (HR) showed a strongly increased risk of death, NRM and RI, in patients with a high transfusion-burden (HR 1.99; P = 0.006, HR of 1.89; P = 0.03 and HR 2.67; P = 0.03). The HR's for ferritin level and comorbidity were not significantly increased.
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Affiliation(s)
- E M P Cremers
- VU University Medical Center, Amsterdam, The Netherlands. .,Department of Hematology, VU University Medical Center, Cancer Center Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
| | - A van Biezen
- Leiden University Medical Center, Leiden, The Netherlands
| | - L C de Wreede
- Leiden University Medical Center, Leiden, The Netherlands
| | - M Scholten
- Leiden University Medical Center, Leiden, The Netherlands
| | - A Vitek
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - J Finke
- University of Freiburg, Freiburg, Germany
| | | | - D Beelen
- University Hospital, Essen, Germany
| | | | - L Volin
- Helsinki University Central Hospital, Helsinki, Finland
| | | | - N Blijlevens
- Radboud University Medical Centre, Nijmegen, The Netherlands
| | - A Nagler
- Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - N Kröger
- University Hospital Eppendorf, Hamburg, Germany
| | - T de Witte
- Radboud University Medical Centre, Nijmegen, The Netherlands
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43
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Allogeneic hematopoietic cell transplantation with double alkylating agents containing reduced-intensity conditioning for patients ⩾60 years with advanced AML/MDS. Leukemia 2016; 30:2426-2429. [PMID: 27573558 DOI: 10.1038/leu.2016.248] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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44
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Byrne M, Savani BN, Mohty M, Nagler A. Peripheral blood stem cell versus bone marrow transplantation: A perspective from the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation. Exp Hematol 2016; 44:567-73. [DOI: 10.1016/j.exphem.2016.04.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Accepted: 04/05/2016] [Indexed: 12/31/2022]
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45
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Versluis J, In 't Hout FEM, Devillier R, van Putten WLJ, Manz MG, Vekemans MC, Legdeur MC, Passweg JR, Maertens J, Kuball J, Biemond BJ, Valk PJM, van der Reijden BA, Meloni G, Schouten HC, Vellenga E, Pabst T, Willemze R, Löwenberg B, Ossenkoppele G, Baron F, Huls G, Cornelissen JJ. Comparative value of post-remission treatment in cytogenetically normal AML subclassified by NPM1 and FLT3-ITD allelic ratio. Leukemia 2016; 31:26-33. [PMID: 27416910 DOI: 10.1038/leu.2016.183] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Revised: 05/25/2016] [Accepted: 06/15/2016] [Indexed: 01/07/2023]
Abstract
Post-remission treatment (PRT) in patients with cytogenetically normal (CN) acute myeloid leukemia (AML) in first complete remission (CR1) is debated. We studied 521 patients with CN-AML in CR1, for whom mutational status of NPM1 and FLT3-ITD was available, including the FLT3-ITD allelic ratio. PRT consisted of reduced intensity conditioning (RIC) allogeneic hematopoietic stem cell transplantation (alloHSCT) (n=68), myeloablative conditioning (MAC) alloHSCT (n=137), autologous hematopoietic stem cell transplantation (autoHSCT) (n=168) or chemotherapy (n=148). Favorable overall survival (OS) was found for patients with mutated NPM1 without FLT3-ITD (71±4%). Outcome in patients with a high FLT3-ITD allelic ratio appeared to be very poor with OS and relapse-free survival (RFS) of 23±8% and 12±6%, respectively. Patients with wild-type NPM1 without FLT3-ITD or with a low allelic burden of FLT3-ITD were considered as intermediate-risk group because of similar OS and RFS at 5 years, in which PRT by RIC alloHSCT resulted in better OS and RFS as compared with chemotherapy (hazard ratio (HR) 0.56, P=0.022 and HR 0.50, P=0.004, respectively) or autoHSCT (HR 0.60, P=0.046 and HR 0.60, P=0.043, respectively). The lowest cumulative incidence of relapse (23±4%) was observed following MAC alloHSCT. These results suggest that alloHSCT may be preferred in patients with molecularly intermediate-risk CN-AML, while the choice of conditioning type may be personalized according to risk for non-relapse mortality.
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Affiliation(s)
- J Versluis
- Department of Hematology, Erasmus University Medical Center Cancer Institute, Rotterdam, The Netherlands
| | - F E M In 't Hout
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Laboratory medicine, Laboratory of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - R Devillier
- Department of Hematology, Erasmus University Medical Center Cancer Institute, Rotterdam, The Netherlands
| | - W L J van Putten
- HOVON Data Center, Erasmus University Medical Center Cancer Institute-Clinical Trial Center, Rotterdam, The Netherlands
| | - M G Manz
- Division of Hematology, University Hospital Zürich, Zürich, Switzerland
| | - M-C Vekemans
- Department of Hematology, Hôpital St Luc, Brussels, Belgium
| | - M-C Legdeur
- Department of Hematology, Medisch Spectrum Twente, Enschede, The Netherlands
| | - J R Passweg
- Stem Cell Transplant Team, University Hospital Basel, Basel, Switzerland
| | - J Maertens
- Department of Hematology, University Hospital Gasthuisberg, Leuven, Belgium
| | - J Kuball
- Department of Immunology and Hematology, University Medical Center, Utrecht, The Netherlands
| | - B J Biemond
- Department of Hematology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - P J M Valk
- Department of Hematology, Erasmus University Medical Center Cancer Institute, Rotterdam, The Netherlands
| | - B A van der Reijden
- Department of Laboratory medicine, Laboratory of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - G Meloni
- Department of Cellular Biotechnologies and Hematology, 'Sapienza' University, Rome, Italy
| | - H C Schouten
- Department of Hematology, University Hospital Maastricht, Maastricht, The Netherlands
| | - E Vellenga
- Department of Hematology, University Medical Center Groningen, Groningen, The Netherlands
| | - T Pabst
- Department of Medical Oncology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - R Willemze
- Department of Hematology, Leiden University Medical Center, Leiden, The Netherlands
| | - B Löwenberg
- Department of Hematology, Erasmus University Medical Center Cancer Institute, Rotterdam, The Netherlands
| | - G Ossenkoppele
- Department of Hematology, VU University Medical Center, Amsterdam, The Netherlands
| | - F Baron
- Department of Hematology, University of Liège, Liège, Belgium
| | - G Huls
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J J Cornelissen
- Department of Hematology, Erasmus University Medical Center Cancer Institute, Rotterdam, The Netherlands
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46
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Relapse of AML after hematopoietic stem cell transplantation: methods of monitoring and preventive strategies. A review from the ALWP of the EBMT. Bone Marrow Transplant 2016; 51:1431-1438. [DOI: 10.1038/bmt.2016.167] [Citation(s) in RCA: 144] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Revised: 05/03/2016] [Accepted: 05/05/2016] [Indexed: 02/07/2023]
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47
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Sohn SK, Moon JH, Lee YJ, Park SW, Kim JY. Survey of experts on therapeutic policies and proposals for the optimal timing for allogeneic peripheral blood stem cell transplantation in transfusion-dependent patients with myelodysplastic syndrome-refractory anemia. Blood Res 2016; 51:44-9. [PMID: 27104191 PMCID: PMC4828528 DOI: 10.5045/br.2016.51.1.44] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 03/09/2016] [Accepted: 03/10/2016] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Most hypomethylating agent (HMA) responders with myelodysplastic syndrome (MDS) eventually need allogeneic stem cell transplantation (SCT) because they often acquire resistance to HMAs within two years of treatment. Considering the nature of MDS and the poor outcomes of SCT when performed after confirming the progression of MDS to acute myeloid leukemia (AML), allogeneic SCT should be performed with caution in patients with low-risk MDS. METHODS To address low-risk MDS, the Korean AML/MDS working party group designed a survey for 34 MDS experts in Korea on therapeutic HMA and allogeneic SCT policies for low-risk MDS. The level of consensus was defined as the percentage of agreement among the experts. RESULTS With regard to the optimal time for allogeneic SCT for HMA responders with MDS-RA, 76% experts agreed that allogeneic SCT should be performed when a patient has a low platelet count. With regard to the relapse pattern that was most commonly found during HMA treatment in responding patients with MDS-RA, 54% experts agreed that the most common pattern that indicated HMA failure was the gradual worsening of cytopenia. CONCLUSION The optimal time to perform allogeneic SCT in RA patients who achieved hematologic complete remission during HMA treatment is when the platelet count decreases. However, these suggestions need to be evaluated in larger future studies. Therefore, careful decisions should be taken at each step of allogeneic SCT to maximize the outcomes for patients with MDS-RA and iron overload.
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Affiliation(s)
- Sang Kyun Sohn
- Department of Hematology, Kyungpook National University Hospital, Daegu, Korea
| | - Joon Ho Moon
- Department of Hematology, Kyungpook National University Hospital, Daegu, Korea
| | - Yoo Jin Lee
- Department of Hematology, Kyungpook National University Hospital, Daegu, Korea
| | - Sung Woo Park
- Department of Hematology, Kyungpook National University Hospital, Daegu, Korea
| | - Ji Yoon Kim
- Department of Hematology, Kyungpook National University Hospital, Daegu, Korea
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48
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Long-term outcomes of allogeneic hematopoietic cell transplantation with intensified myeloablative conditioning for refractory myeloid malignancy. Bone Marrow Transplant 2016; 51:869-71. [PMID: 26878661 DOI: 10.1038/bmt.2016.15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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49
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Sengsayadeth S, Savani BN, Blaise D, Malard F, Nagler A, Mohty M. Reduced intensity conditioning allogeneic hematopoietic cell transplantation for adult acute myeloid leukemia in complete remission - a review from the Acute Leukemia Working Party of the EBMT. Haematologica 2016; 100:859-69. [PMID: 26130513 DOI: 10.3324/haematol.2015.123331] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Acute myeloid leukemia is the most common indication for an allogeneic hematopoietic cell transplant. The introduction of reduced intensity conditioning has expanded the recipient pool for transplantation, which has importantly made transplant an option for the more commonly affected older age groups. Reduced intensity conditioning allogeneic transplantation is currently the standard of care for patients with intermediate or high-risk acute myeloid leukemia and is now most often employed in older patients and those with medical comorbidities. Despite being curative for a significant proportion of patients, post-transplant relapse remains a challenge in the reduced intensity conditioning setting. Herein we discuss the studies that demonstrate the feasibility of reduced intensity conditioning allogeneic transplants, compare the outcomes of reduced intensity conditioning versus chemotherapy and conventional myeloablative conditioning regimens, describe the optimal donor and stem cell source, and consider the impact of post-remission consolidation, comorbidities, center experience, and more intensive (reduced toxicity conditioning) regimens on outcomes. Additionally, we discuss the need for further prospective studies to optimize transplant outcomes.
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Affiliation(s)
- Salyka Sengsayadeth
- Section of Hematology and Stem Cell Transplant, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Bipin N Savani
- Section of Hematology and Stem Cell Transplant, Vanderbilt University Medical Center, Nashville, TN, USA Acute Leukemia Working Party of the EBMT, Marseille, France
| | - Didier Blaise
- Programme de Transplantation & Therapie Cellulaire - Centre de Recherche en Cancérologie de Marseille - Institut Paoli Calmettes, Marseille, France
| | - Florent Malard
- Department of Haematology, Saint Antoine Hospital, Paris, France INSERM UMR 938, Paris, France Université Pierre et Marie Curie, Paris, France
| | - Arnon Nagler
- Acute Leukemia Working Party of the EBMT, Marseille, France Hematology Division, Chaim Sheba Medical Center, Tel Hashomer, Israel EBMT Paris Study Office/CEREST-TC, Paris, France
| | - Mohamad Mohty
- Department of Haematology, Saint Antoine Hospital, Paris, France INSERM UMR 938, Paris, France Université Pierre et Marie Curie, Paris, France EBMT Paris Study Office/CEREST-TC, Paris, France
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50
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Cruijsen M, Hobo W, van der Velden WJFM, Bremmers MEJ, Woestenenk R, Bär B, Falkenburg JHF, Kester M, Schaap NPM, Jansen J, Blijlevens NNM, Dolstra H, Huls G. Addition of 10-Day Decitabine to Fludarabine/Total Body Irradiation Conditioning is Feasible and Induces Tumor-Associated Antigen-Specific T Cell Responses. Biol Blood Marrow Transplant 2016; 22:1000-1008. [PMID: 26860635 DOI: 10.1016/j.bbmt.2016.02.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 02/01/2016] [Indexed: 01/21/2023]
Abstract
Allogeneic hematopoietic cell transplantation (HCT) offers the possibility of curative therapy for patients with myelodysplastic syndromes (MDS), chronic myelomonocytic leukemia (CMML), and acute myelogenous leukemia (AML). However, post-HCT relapse remains a major problem, particularly in patients with high-risk cytogenetics and in patients who cannot tolerate consolidation chemotherapy (eg, due to previous toxicity). We assessed the toxicity and efficacy of 10-day decitabine (Dec), fludarabine (Flu), and 2 Gy total body irradiation (TBI) as a new conditioning regimen for allogeneic HCT in patients with MDS, CMML, or AML. Thirty patients were enrolled, including 11 with MDS, 2 with CMML, and 17 with AML. Patients received 20 mg/m(2)/day Dec on days -11 to -2, 30 mg/m(2)/day Flu on days -4 to -2, and 2 Gy TBI on day -1, followed by infusion of a donor stem cell graft on day 0. Postgrafting immunosuppression consisted of cyclosporin A and mycophenolate mofetil. At a median follow-up of 443 days, the overall survival was 53%, relapse incidence was 27%, and nonrelapse mortality was 27%. The incidence of severe acute (grade III/IV) graft-versus-host disease (GVHD) was 27%, and that of (predominantly mild) chronic GVHD was 60%. Immunomonitoring studies revealed that specific CD8(+) T cell responses against epigenetically silenced tumor-associated antigens (TAAs), including cancer-testis antigens (MAGE-A1/A2/A3 and PRAME) and RHAMM, occurred more frequently in patients who had received Dec/Flu/TBI conditioning (8 of 11 patients) compared with a control group of patients who had received only Flu/TBI conditioning (2 of 9 patients). In summary, Dec/Flu/TBI conditioning proved feasible and effective and enhanced the induction of TAA-reactive CD8(+) T cell responses in vivo, which may contribute to disease control post-transplantation.
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Affiliation(s)
- Marjan Cruijsen
- Department of Hematology, Radboudumc, Nijmegen, the Netherlands
| | - Willemijn Hobo
- Department of Laboratory Medicine, Laboratory of Hematology, Radboudumc, Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands
| | | | | | - Rob Woestenenk
- Department of Laboratory Medicine, Laboratory of Hematology, Radboudumc, Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands
| | - Brigitte Bär
- Department of Hematology, Radboudumc, Nijmegen, the Netherlands
| | | | - Michel Kester
- Department of Hematology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Joop Jansen
- Department of Laboratory Medicine, Laboratory of Hematology, Radboudumc, Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands
| | | | - Harry Dolstra
- Department of Laboratory Medicine, Laboratory of Hematology, Radboudumc, Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands
| | - Gerwin Huls
- Department of Hematology, Radboudumc, Nijmegen, the Netherlands; Department of Laboratory Medicine, Laboratory of Hematology, Radboudumc, Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands.
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