CD34 + Cell Selection versus Reduced-Intensity Conditioning and Unmodified Grafts for Allogeneic Hematopoietic Cell Transplantation in Patients Age >50 Years with Acute Myelogenous Leukemia and Myelodysplastic Syndrome
Barba, Pere (Hospital Universitari Vall d'Hebron)
Martino Bofarull, Rodrigo (Institut d'Investigació Biomèdica Sant Pau)
Zhou, Qin (Memorial Sloan Kettering Cancer Center)
Cho, Christina (Weill Cornell Medical College)
Castro-Malaspina, Hugo (Weill Cornell Medical College)
Devlin, Sean M (Memorial Sloan Kettering Cancer Center)
Esquirol, Albert (Institut d'Investigació Biomèdica Sant Pau)
Giralt, Sergio (Weill Cornell Medical College)
Jakubowski, Ann A. (Weill Cornell Medical College)
Caballero, Dolores (Hospital Universitario Salamanca (CAUSA/IBSAL))
Maloy, Molly (Memorial Sloan Kettering Cancer Center)
Papadopoulos, Esperanza B. (Weill Cornell Medical College)
Piñana, José Luis (Hospital Clínic Universitari (València))
Fox, Maria Laura (Hospital Universitari Vall d'Hebron)
Márquez-Malaver, Francisco J. (Hospital Universitario Virgen del Rocío (Sevilla, Andalusia))
Valcárcel, David (Hospital Universitari Vall d'Hebron)
Solano, Carlos (Hospital Clínic Universitari (València))
López-Corral, Lucía (Hospital Universitario Salamanca (CAUSA/IBSAL))
Malouf Sierra, Jorge 1971- (Institut d'Investigació Biomèdica Sant Pau)
Perales, Miguel-Angel (Weill Cornell Medical College)
Universitat Autònoma de Barcelona

Date:	2018
Abstract:	Reduced-intensity conditioning (RIC) and T cell depletion (TCD) through CD34 cell selection without the use of post-transplantation immunosuppression are 2 strategies used to reduce nonrelapse mortality (NRM) in older patients after allogeneic hematopoietic cell transplantation (allo-HCT). To compare the efficacy of the RIC and TCD approaches, we evaluated the outcomes of patients age >50 years with acute myelogenous leukemia (AML) and myelodysplastic syndrome (MDS) who underwent allo-HCT from an HLA-matched donor with one of these strategies. Baseline characteristics were comparable in the patients receiving TCD (n = 204) and those receiving RIC (n = 151), except for a higher proportion of unrelated donors (68% versus 40%; P <. 001) and a higher comorbidity burden (Hematopoietic Cell Transplantation Comorbidity Index [HCT-CI] ≥3: 51% versus 38%; P <. 001) in the TCD cohort. Analysis of outcomes at 3 years showed a higher chronic graft-versus-host disease (GVHD)/relapse-free survival (CRFS) (51% versus 7%; P <. 001), lower incidences of grade II-IV acute GVHD (18% versus 46% at day +180) and chronic GVHD (6% versus 55% at 3 years; P <. 001), and a lower incidence of relapse (19% versus 33% at 3 years; P =. 001) in the TCD group compared with the RIC group. Relapse-free survival (RFS), overall survival (OS), and NRM were similar in the 2 groups. Combining transplantation approach (RIC versus TCD) and comorbidity burden (HCT-CI 0-2 versus ≥3), patients with an HCT-CI score of 0-2 seemed to benefit from the TCD approach. In conclusion, in this retrospective study, the use of a CD34 cell-selected graft and a myeloablative conditioning regimen was associated with higher CRFS and similar RFS and OS compared with unmodified allo-RIC in patients age >50 years with AML and MDS.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Allogeneic hematopoietic cell transplantation ; GVHD ; RIC ; T cell depletion
Published in:	Biology of blood and marrow transplantation, Vol. 24 Núm. 5 (may 2018) , p. 964-972, ISSN 1523-6536

DOI: 10.1016/j.bbmt.2017.12.804
PMID: 29305194

25 p, 635.6 KB

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