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Myeloablative vs reduced-intensity conditioning allogeneic hematopoietic cell transplantation for chronic myeloid leukemia
Med Coll Wisconsin, Dept Med, Div Hematol Oncol, 9200 W Wisconsin Ave, Milwaukee, WI 53226 USA.ORCID iD: 0000-0001-9117-8696
Med Coll Wisconsin, Inst Hlth & Soc, Dept Biostat, Milwaukee, WI 53226 USA;Med Coll Wisconsin, Dept Med, Ctr Int Blood & Marrow Transplant Res, Milwaukee, WI 53226 USA.
Med Coll Wisconsin, Dept Med, Ctr Int Blood & Marrow Transplant Res, Milwaukee, WI 53226 USA.
Med Univ South Carolina, Dept Med, Div Hematol Oncol, Charleston, SC 29425 USA.
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2018 (English)In: BLOOD ADVANCES, ISSN 2473-9529, Vol. 2, no 21, p. 2922-2936Article in journal (Refereed) Published
Abstract [en]

Allogeneic hematopoietic cell transplantation (allo-HCT) is a potentially curative treatment of chronic myeloid leukemia (CML). Optimal conditioning intensity for allo-HCT for CML in the era of tyrosine kinase inhibitors (TKIs) is unknown. Using the Center for International Blood and Marrow Transplant Research database, we sought to determine whether reduced-intensity/nonmyeloablative conditioning (RIC) allo-HCT and myeloablative conditioning (MAC) result in similar outcomes in CML patients. We evaluated 1395 CML allo-HCT recipients between the ages of 18 and 60 years. The disease status at transplant was divided into the following categories: chronic phase 1, chronic phase 2 or greater, and accelerated phase. Patients in blast phase at transplant and alternative donor transplants were excluded. The primary outcome was overall survival (OS) after allo-HCT. MAC (n = 1204) and RIC allo-HCT recipients (n = 191) from 2007 to 2014 were included. Patient, disease, and transplantation characteristics were similar, with a few exceptions. Multivariable analysis showed no significant difference in OS between MAC and RIC groups. In addition, leukemia-free survival and nonrelapse mortality did not differ significantly between the 2 groups. Compared with MAC, the RIC group had a higher risk of early relapse after allo-HCT (hazard ratio [HR], 1.85; P = .001). The cumulative incidence of chronic graft-versus-host disease (cGVHD) was lower with RIC than with MAC (HR, 0.77; P = .02). RIC provides similar survival and lower cGVHD compared with MAC and therefore may be a reasonable alternative to MAC for CML patients in the TKI era.

Place, publisher, year, edition, pages
2018. Vol. 2, no 21, p. 2922-2936
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Hematology
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URN: urn:nbn:se:uu:diva-371540DOI: 10.1182/bloodadvances.2018024844ISI: 000450684800012PubMedID: 30396912OAI: oai:DiVA.org:uu-371540DiVA, id: diva2:1275802
Available from: 2019-01-07 Created: 2019-01-07 Last updated: 2019-01-07Bibliographically approved

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