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- Title
Myeloablative vs nonmyeloablative allogeneic transplantation for patients with myelodysplastic syndrome or acute myelogenous leukemia with multilineage dysplasia: a retrospective analysis.
- Authors
Scott, B. L.; Sandmaier, B. M.; Storer, B.; Maris, M. B.; Sorror, M. L.; Maloney, D. G.; Chauncey, T. R.; Storb, R.; Deeg, H. J.
- Abstract
Transplant outcome was analyzed in 150 patients with myelodysplastic syndrome (MDS) or acute myelogenous leukemia transformed from MDS (tAML) conditioned with nonmyeloablative or myeloablative regimens. A total of 38 patients received nonmyeloablative regimens of 2 Gy total body irradiation alone (n=2) or with fludarabine (n=36), 90mg/m2. A total of 112 patients received a myeloablative regimen of busulfan, 16mg/ kg (targeted to 800-900 ng/ml), and cyclophosphamide 120 mg/ kg. Nonmyeloablative patients were older (median age 62 vs 52 years, P<0.001), more frequently had progressed to tAML (53 vs 31%, P=0.06), had higher risk disease by the International Prognostic Scoring System (53 vs 30%, P=0.004), had higher transplant specific comorbidity indices (68 vs 42%, P=0.01) and more frequently had durable complete responses to induction chemotherapy (58 vs 14%). Three-year overall survival (27%/48% (P=0.56)), progression-free survival (28%/4 44%, (P=0.60)), and nonrelapse mortality (41%/34%, (P=0.94)) did not differ significantly between nonmyeloblative/myeloablative conditioning. Overall (HR=0.9, P=0.84) and progression-free survivals (HR=1, P=0.93) were similar for patients with chemotherapy-induced remissions irrespective of conditioning intensity. Graft vs leukemia effects may be more important than conditioning intensity in preventing progression in patients in chemotherapy-induced remissions at the time of transplantation. Randomized prospective studies are needed to further address the optimal choice of transplant conditioning intensity in myeloid neoplasms.
- Subjects
MYELODYSPLASTIC syndromes; CELL transformation; DYSPLASIA; BONE marrow diseases; LEUKEMIA; ANEMIA; ACUTE myeloid leukemia treatment; MYELODYSPLASTIC syndromes treatment; IMMUNOSUPPRESSIVE agents; ANTINEOPLASTIC agents; CELL differentiation; GRAFT versus host disease; HEMATOPOIETIC stem cell transplantation; HOMOGRAFTS; IMMUNOSUPPRESSION; PROGNOSIS; RESEARCH funding; SURVIVAL; TRANSPLANTATION immunology; ACUTE myeloid leukemia; TREATMENT effectiveness; RETROSPECTIVE studies; DISEASE progression; DISEASE complications; THERAPEUTICS
- Publication
Leukemia (08876924), 2006, Vol 20, Issue 1, p128
- ISSN
0887-6924
- Publication type
journal article
- DOI
10.1038/sj.leu.2404010