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Comparative Study
. 2018 May;24(5):964-972.
doi: 10.1016/j.bbmt.2017.12.804. Epub 2018 Jan 2.

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

Pere Barba  1 , Rodrigo Martino  2 , Qin Zhou  3 , Christina Cho  4 , Hugo Castro-Malaspina  4 , Sean Devlin  3 , Albert Esquirol  2 , Sergio Giralt  4 , Ann A Jakubowski  4 , Dolores Caballero  5 , Molly Maloy  6 , Esperanza B Papadopoulos  4 , José Luís Piñana  7 , María Laura Fox  8 , Francisco J Márquez-Malaver  9 , David Valcárcel  8 , Carlos Solano  7 , Lucía López-Corral  5 , Jorge Sierra  2 , Miguel-Angel Perales  10
Affiliations
Comparative Study

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

Pere Barba et al. Biol Blood Marrow Transplant. 2018 May.

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.

Keywords: Allogeneic hematopoietic cell transplantation; GVHD; RIC; T cell depletion.

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Figures

Figure 1:
Figure 1:
Probability of OS (A) and RFS (B) according to transplant approach
Figure 2:
Figure 2:
Probability of CRFS according to transplant approach
Figure 3:
Figure 3:
Cumulative Incidence of NRM (A) and relapse (B) according to transplant approach
Figure 4:
Figure 4:
Cumulative Incidence of acute (A) and chronic (B) GVHD
Figure 5:
Figure 5:
Probability of OS (A) and CRFS (B) according to transplant approach and comorbidity burden Footnote Figure 5. Patients were categorized into 4 subgroups: TCD and HCT-CI = 0–2 (n = 100), TCD and HCT-CI ≥ 3 (n = 104), RIC and HCT-CI = 0–2 (n = 94) and RIC and HCT-CI ≥ 3 (n = 58)
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