Myeloablative vs nonmyeloablative allogeneic transplantation for patients with myelodysplastic syndrome or acute myelogenous leukemia with multilineage dysplasia: a retrospective analysis.
| Autor: | 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. |
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| Předmět: |
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 |
| Zdroj: | Leukemia (08876924); Jan2006, Vol. 20 Issue 1, p128-135, 8p, 2 Charts, 3 Graphs |
| Abstrakt: | 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. [ABSTRACT FROM AUTHOR] |
| Databáze: | Complementary Index |
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