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.
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The CIBMTR is supported primarily by the National Institutes of Health (public health service grant/cooperative agreement 5U24CA076518 from the National Cancer Institute, National Heart, Lung, and Blood Institute, and National Institute of Allergy and Infectious Diseases and grant/cooperative agreement 4U10HL069294 from the National Heart, Lung, and Blood Institute and National Cancer Institute), the Health Resources and Services Administration/Department of Health and Human Services (contract HHSH250201200016C), and the Office of Naval Research (grants N00014-17-1-2388 and N0014-17-1-2850). The CIBMTR is also supported by Actinium Pharmaceuticals, Amgen, Amneal Biosciences, Angiocrine Bioscience, and anonymous donation to the Medical College of Wisconsin, Astellas Pharma US, Atara Biotherapeutics, Be the Match Foundation; bluebird bio, Bristol Myers Squibb Oncology, Celgene Corporation, Cerus Corporation; Chimerix, the Fred Hutchinson Cancer Research Center, Gamida Cell, Gilead Sciences, HistoGenetics, Immucor, Incyte Corporation, Janssen Scientific Affairs, Jazz Pharmaceuticals, Juno Therapeutics, Karyopharm Therapeutics, Kite Pharma, Medac, MedImmune, The Medical College of Wisconsin, Mediware, Merck & Co, Mesoblast, MesoScale Diagnostics, Millennium, Miltenyi Biotec, the National Marrow Donor Program, Neovii Biotech NA, Novartis Pharmaceuticals Corporation, Otsuka Pharmaceutical (Japan), Patient-Centered Outcomes Research Institute, Pfizer, Pharmacyclics, PIRCHE, Sanofi Genzyme, Seattle Genetics, Shire, Spectrum Pharmaceuticals, St. Baldrick’s Foundation, Sunesis Pharmaceuticals, Swedish Orphan Biovitrum, Takeda Oncology, Telomere Diagnostics, and the University of Minnesota.
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Chhabra, Saurabh; Ahn, Kwang Woo; Hu, Zhen-Huan; Jain, Sandeep; Assal, Amer; Cerny, Jan; Copelan, Edward A.; Daly, Andrew; DeFilipp, Zachariah; Gadalla, Shahinaz M; Gale, Robert Peter; Ganguly, Siddhartha; Hamilton, Betty K.; Hildebrandt, Gerhard C.; Hsu, Jack W.; Inamoto, Yoshihiro; Kanate, Abraham S.; Khoury, H. Jean; Lazarus, Hillard M.; Litzow, Mark R.; Nathan, Sunita; Olsson, Richard F.; Pawarode, Attaphol; Ringden, Olle; Rowe, Jacob M.; Saad, Ayman; Savani, Bipin N.; Schouten, Harry C.; Seo, Sachiko; and Shah, Nirav N., "Myeloablative vs Reduced-Intensity Conditioning Allogeneic Hematopoietic Cell Transplantation for Chronic Myeloid Leukemia" (2018). Markey Cancer Center Faculty Publications. 119.