Reduced intensity versus non-myeloablative conditioning regimen for haploidentical transplantation and post-transplantation cyclophosphamide in complete remission acute myeloid leukemia: a study from the ALWP of the EBMT. - Université de Lille Accéder directement au contenu
Article Dans Une Revue Bone Marrow Transplantation Année : 2022

Reduced intensity versus non-myeloablative conditioning regimen for haploidentical transplantation and post-transplantation cyclophosphamide in complete remission acute myeloid leukemia: a study from the ALWP of the EBMT.

Jacques-Emmanuel Galimard
  • Fonction : Auteur
Myriam Labopin
  • Fonction : Auteur
Didier Blaise
Anna-Maria Raiola
  • Fonction : Auteur
Jiri Pavlu
  • Fonction : Auteur
Luca Castagna
  • Fonction : Auteur
Yves Chalandon
  • Fonction : Auteur
Massimo Martino
  • Fonction : Auteur
F. Stölzel
  • Fonction : Auteur
G. Bug
  • Fonction : Auteur
B. Bruno
  • Fonction : Auteur
R. Vrhovac
  • Fonction : Auteur
A. Olivieri
  • Fonction : Auteur
H. Arroyo
  • Fonction : Auteur
D. Avenoso
  • Fonction : Auteur
A. Neubauer
  • Fonction : Auteur
Eolia Brissot
B. Savani
  • Fonction : Auteur
A. Nagler
  • Fonction : Auteur

Résumé

The optimal conditioning regimen prior haploidentical stem cell transplantation (Haplo-SCT) with post transplantation cyclophosphamide (PT-Cy) for acute myeloid leukemia (AML) remains unknown. A non-myeloablative conditioning (NMAC) regimen (cyclophosphamide + fludarabine + TBI 2 Gy [CyFluTBI]) is a safe approach, but relapse incidence remains high in this setting. Alternatively, a reduced intensity conditioning (RIC) regimen combining thiotepa and reduced-dose busulfan with fludarabine (TBF) may decrease AML relapse. However, an excess of toxicity may counterbalance this potential benefit. We retrospectively compared CyFluTBI vs. TBF in CR AML patients who underwent Haplo-SCT with PT-Cy, in two different populations based on age. We analyzed 490 patients. In patients aged <60 years (n = 203), we observed a higher RI (HR = 3.59, 95% CI = 1.75–7.37, p < 0.01), lower LFS (HR = 1.98, 95% CI = 1.22–3.22, p < 0.01) and lower OS (HR = 1.73, 95% CI = 1.04–2.88, p = 0.04) in the CyFluTBI group, without significant difference in NRM. In older patients (n = 287), we observed that conditioning regimen did not significantly influence LFS (HR = 0.90, 95% CI = 0.56–1.44, p = 0.65), OS (HR = 0.81, 95% CI = 0.49–1.32, p = 0.39) and RI (HR = 1.78, 95% CI = 0.90–3.50, p = 0.10), but showed that CyFluTBI was associated with a significantly lower risk of NRM (HR = 0.48, 95% CI = 0.25–0.92, p = 0.03). Thus, younger patients seem to benefit from conditioning intensification from CyFluTBI to TBF regimens prior PT-Cy Haplo-SCT for CR AML, while older ones do not.
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Dates et versions

hal-04526600 , version 1 (29-03-2024)

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Citer

Raynier Devillier, Jacques-Emmanuel Galimard, Myriam Labopin, Didier Blaise, Anna-Maria Raiola, et al.. Reduced intensity versus non-myeloablative conditioning regimen for haploidentical transplantation and post-transplantation cyclophosphamide in complete remission acute myeloid leukemia: a study from the ALWP of the EBMT.. Bone Marrow Transplantation, 2022, Bone Marrow Transplantation, 57, pp.1421-1427. ⟨10.1038/s41409-022-01674-x⟩. ⟨hal-04526600⟩
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