Equivalent outcomes using reduced intensity or conventional myeloablative conditioning transplantation for patients aged 35 years and over with AML.
Fiche publication
Date publication
janvier 2015
Journal
Bone marrow transplantation
Auteurs
Membres identifiés du Cancéropôle Est :
Pr DELMER Alain
Tous les auteurs :
Sébert M, Porcher R, Robin M, Adès L, Boissel N, Raffoux E, Xhaard A, Dhedin N, Larghero J, Himberlin C, Delmer A, Fenaux P, Dombret H, Socié G, de Latour RP
Lien Pubmed
Résumé
Allogeneic hematopoietic stem cell transplantation provides the best chance of long-term survival for patients with AML, but is associated with an unpredictable risk of treatment-related mortality. From January 2000 to December 2010, we compared the outcomes for patients with AML aged 35 and over using reduced-intensity conditioning (RIC, N=60) or conventional myeloablative conditioning (MAC) regimen (N=72) transplantation. The median follow-up was 47 months (10-134). The 4-year cumulative incidence of non-relapse mortality was 21%. After adjusting for cytogenetic risk, gender donor/recipient mismatch and CD34+ cells, non-relapse mortality was significantly lower with the RIC regimen (P=0.027). The 4-year cumulative incidence of relapse was 38% and no difference was observed in the adjusted relapse rate between the two groups. The 4-year OS rate was 46%. Using both Cox regression and inverse probability-of-treatment weighted (IPTW) method, a similar OS rate was found with both regimens (adjusted hazard ratios for conventional vs reduced of 1.14 (95% CI 0.67-1.93, P=0.64) with Cox regression, and 1.14 (95% CI 0.55-2.34, P=0.73) with IPTW). Until prospective trials are completed, this study supports the use of a reduced-intensity regimen prior to transplantation for patients with AML aged 35 and over.
Mots clés
Adult, Age Factors, Aged, Allografts, Disease-Free Survival, Follow-Up Studies, Hematopoietic Stem Cell Transplantation, Humans, Leukemia, Myeloid, Acute, mortality, Male, Middle Aged, Sex Factors, Survival Rate, Transplantation Conditioning
Référence
Bone Marrow Transplant.. 2015 Jan;50(1):74-81