TY - JOUR
T1 - Comparable Antileukemia/Lymphoma Effects in Nonremission Patients Undergoing Allogeneic Hematopoietic Cell Transplantation with a Conventional Cytoreductive or Reduced-Intensity Regimen
AU - Maruyama, Dai
AU - Fukuda, Takahiro
AU - Kato, Ruri
AU - Yamasaki, Satoshi
AU - Usui, Eiji
AU - Morita-Hoshi, Yuriko
AU - Kim, Sung Won
AU - Mori, Shin ichiro
AU - Heike, Yuji
AU - Makimoto, Atsushi
AU - Tajima, Kinuko
AU - Tanosaki, Ryuji
AU - Tobinai, Kensei
AU - Takaue, Yoichi
N1 - Funding Information:
This work was supported in part by grants from the Ministry of Health, Labor and Welfare, Japan. This paper was presented in part as a poster presentation at the 47th Annual Meeting of the American Society of Hematology, Atlanta, GA, December 2005. We thank the medical, nursing, data processing, and laboratory staffs at National Cancer Center Hospital for their important contributions to this study through dedicated care of the patients. We also thank Yukio Kobayashi, Takashi Watanabe, Fusako Ohara, and Kazuaki Yokoyama for their helpful discussions.
PY - 2007/8
Y1 - 2007/8
N2 - To evaluate the potential of allogeneic hematopoietic cell transplantation (HCT) with a reduced-intensity conditioning regimen (RIST) for the treatment of patients with hematologic malignancies not in remission, we retrospectively reviewed the medical records of 132 patients (89 leukemia or myelodysplastic syndrome, 40 malignant lymphoma, and 3 others) who received conventional myeloablative HCT (CST, n = 52) or RIST (n = 80). The median age of the RIST group was significantly higher than that of the CST group (53 years versus 40 years, P < .01). The RIST group also included a higher proportion of patients with an HCT-specific comorbidity index (HCT-CI) of 1 or more than the CST group (65% versus 37%, P = .03). The probabilities of achieving complete remission and the incidences of grades II-IV and III-IV acute graft-versus-host disease (aGVHD) in the CST and RIST groups were, respectively, 77% and 64%, 50% and 50%, and 23% and 28%, with no significant differences. Similarly, there was no difference in the 2-year probabilities of nonrelapse mortality (NRM, 36% and 38%), progressive disease or relapse (PD 51% and 49%), overall survival (OS, 31% and 38%), and progression-free survival (PFS, 28% and 29%). Multivariate analyses revealed that a higher HCT-CI score and transplant from donors other than HLA-matched relatives were associated with increased risks of NRM and poor OS, and patients who received chemotherapy within 2 months before HCT were associated with increased risks of PD, poor OS, and PFS after transplantation. After adjusting for these variables, the risks of NRM, PD, OS, and PFS in the RIST group were not significantly different from those in the CST group. In conclusion, these results suggest that the antileukemia/lymphoma effect associated with RIST is comparable to that associated with CST. RIST appears to be feasible for the treatment of hematologic malignancies not in remission.
AB - To evaluate the potential of allogeneic hematopoietic cell transplantation (HCT) with a reduced-intensity conditioning regimen (RIST) for the treatment of patients with hematologic malignancies not in remission, we retrospectively reviewed the medical records of 132 patients (89 leukemia or myelodysplastic syndrome, 40 malignant lymphoma, and 3 others) who received conventional myeloablative HCT (CST, n = 52) or RIST (n = 80). The median age of the RIST group was significantly higher than that of the CST group (53 years versus 40 years, P < .01). The RIST group also included a higher proportion of patients with an HCT-specific comorbidity index (HCT-CI) of 1 or more than the CST group (65% versus 37%, P = .03). The probabilities of achieving complete remission and the incidences of grades II-IV and III-IV acute graft-versus-host disease (aGVHD) in the CST and RIST groups were, respectively, 77% and 64%, 50% and 50%, and 23% and 28%, with no significant differences. Similarly, there was no difference in the 2-year probabilities of nonrelapse mortality (NRM, 36% and 38%), progressive disease or relapse (PD 51% and 49%), overall survival (OS, 31% and 38%), and progression-free survival (PFS, 28% and 29%). Multivariate analyses revealed that a higher HCT-CI score and transplant from donors other than HLA-matched relatives were associated with increased risks of NRM and poor OS, and patients who received chemotherapy within 2 months before HCT were associated with increased risks of PD, poor OS, and PFS after transplantation. After adjusting for these variables, the risks of NRM, PD, OS, and PFS in the RIST group were not significantly different from those in the CST group. In conclusion, these results suggest that the antileukemia/lymphoma effect associated with RIST is comparable to that associated with CST. RIST appears to be feasible for the treatment of hematologic malignancies not in remission.
KW - Leukemia
KW - Lymphoma
KW - Transplantation
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U2 - 10.1016/j.bbmt.2007.04.004
DO - 10.1016/j.bbmt.2007.04.004
M3 - Article
C2 - 17640597
AN - SCOPUS:34447332877
SN - 1083-8791
VL - 13
SP - 932
EP - 941
JO - Biology of Blood and Marrow Transplantation
JF - Biology of Blood and Marrow Transplantation
IS - 8
ER -