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Reduced intensity conditioning regimens including alkylating chemotherapy do not alter survival outcomes after allogeneic hematopoietic cell transplantation in chronic lymphocytic leukemia compared to low-intensity non-myeloablative conditioning

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@article{5dee57f311ab43ab8edd568bf923973d,
title = "Reduced intensity conditioning regimens including alkylating chemotherapy do not alter survival outcomes after allogeneic hematopoietic cell transplantation in chronic lymphocytic leukemia compared to low-intensity non-myeloablative conditioning",
abstract = "PURPOSE: The optimal dose intensity for conditioning prior to allogeneic hematopoietic stem cell transplantation (alloHSCT) for chronic lymphocytic leukemia (CLL) is unknown.METHODS: We retrospectively compared outcomes of patients who received a first alloHCST after non-myeloablative (NMA) and reduced intensity conditioning (RIC). Data of 432 patients with a median age of 55 years were included, of which 86 patients underwent NMA and 346 RIC.RESULTS: The median follow-up after alloHSCT was 4.3 years. Compared to the RIC group, more NMA patients had purine-analog-sensitive disease, were in complete remission and received matched related donor transplantation. After RIC, the probabilities for 5-year OS, EFS, CIR, and NRM were 46{\%}, 38{\%}, 28{\%}, and 35{\%} and after NMA the respective probabilities were 52{\%}, 43{\%}, 25{\%}, and 32{\%}. In multivariate analysis, remission status prior to conditioning but not RIC versus NMA conditioning had a significant impact on CIR, EFS, and OS.CONCLUSION: Presumed higher anti-leukemic activity of RIC versus NMA conditioning did not translate into better outcomes after alloHSCT, but better remission status prior to conditioning did. Effective pathway inhibitor-based salvage therapies combined with NMA conditioning might thus represent the most attractive contemporary approach for alloHSCT for patients with CLL.",
keywords = "Adult, Aged, Antineoplastic Combined Chemotherapy Protocols/therapeutic use, Busulfan/administration & dosage, Combined Modality Therapy, Cyclophosphamide/administration & dosage, Female, Follow-Up Studies, Graft vs Host Disease/epidemiology, Hematopoietic Stem Cell Transplantation/mortality, Humans, Incidence, Leukemia, Lymphocytic, Chronic, B-Cell/mortality, Male, Melphalan/administration & dosage, Middle Aged, Prognosis, Remission Induction, Retrospective Studies, Survival Rate, Transplantation Conditioning/mortality, Transplantation, Homologous, Young Adult",
author = "Andersen, {Niels Smedegaard} and Martin Bornh{\"a}user and Martin Gramatzki and Peter Dreger and Antonin Vitek and Michal Karas and Mauricette Michallet and Carol Moreno and {van Gelder}, Michel and Anja Henseler and {de Wreede}, {Liesbeth C} and Stefan Sch{\"o}nland and Nicolaus Kr{\"o}ger and Johannes Schetelig and {CLL subcommittee, Chronic Malignancies Working Party}",
year = "2019",
month = "11",
doi = "10.1007/s00432-019-03014-x",
language = "English",
volume = "145",
pages = "2823--2834",
journal = "European Journal of Cancer and Clinical Oncology",
issn = "0171-5216",
publisher = "Springer",
number = "11",

}

RIS

TY - JOUR

T1 - Reduced intensity conditioning regimens including alkylating chemotherapy do not alter survival outcomes after allogeneic hematopoietic cell transplantation in chronic lymphocytic leukemia compared to low-intensity non-myeloablative conditioning

AU - Andersen, Niels Smedegaard

AU - Bornhäuser, Martin

AU - Gramatzki, Martin

AU - Dreger, Peter

AU - Vitek, Antonin

AU - Karas, Michal

AU - Michallet, Mauricette

AU - Moreno, Carol

AU - van Gelder, Michel

AU - Henseler, Anja

AU - de Wreede, Liesbeth C

AU - Schönland, Stefan

AU - Kröger, Nicolaus

AU - Schetelig, Johannes

AU - CLL subcommittee, Chronic Malignancies Working Party

PY - 2019/11

Y1 - 2019/11

N2 - PURPOSE: The optimal dose intensity for conditioning prior to allogeneic hematopoietic stem cell transplantation (alloHSCT) for chronic lymphocytic leukemia (CLL) is unknown.METHODS: We retrospectively compared outcomes of patients who received a first alloHCST after non-myeloablative (NMA) and reduced intensity conditioning (RIC). Data of 432 patients with a median age of 55 years were included, of which 86 patients underwent NMA and 346 RIC.RESULTS: The median follow-up after alloHSCT was 4.3 years. Compared to the RIC group, more NMA patients had purine-analog-sensitive disease, were in complete remission and received matched related donor transplantation. After RIC, the probabilities for 5-year OS, EFS, CIR, and NRM were 46%, 38%, 28%, and 35% and after NMA the respective probabilities were 52%, 43%, 25%, and 32%. In multivariate analysis, remission status prior to conditioning but not RIC versus NMA conditioning had a significant impact on CIR, EFS, and OS.CONCLUSION: Presumed higher anti-leukemic activity of RIC versus NMA conditioning did not translate into better outcomes after alloHSCT, but better remission status prior to conditioning did. Effective pathway inhibitor-based salvage therapies combined with NMA conditioning might thus represent the most attractive contemporary approach for alloHSCT for patients with CLL.

AB - PURPOSE: The optimal dose intensity for conditioning prior to allogeneic hematopoietic stem cell transplantation (alloHSCT) for chronic lymphocytic leukemia (CLL) is unknown.METHODS: We retrospectively compared outcomes of patients who received a first alloHCST after non-myeloablative (NMA) and reduced intensity conditioning (RIC). Data of 432 patients with a median age of 55 years were included, of which 86 patients underwent NMA and 346 RIC.RESULTS: The median follow-up after alloHSCT was 4.3 years. Compared to the RIC group, more NMA patients had purine-analog-sensitive disease, were in complete remission and received matched related donor transplantation. After RIC, the probabilities for 5-year OS, EFS, CIR, and NRM were 46%, 38%, 28%, and 35% and after NMA the respective probabilities were 52%, 43%, 25%, and 32%. In multivariate analysis, remission status prior to conditioning but not RIC versus NMA conditioning had a significant impact on CIR, EFS, and OS.CONCLUSION: Presumed higher anti-leukemic activity of RIC versus NMA conditioning did not translate into better outcomes after alloHSCT, but better remission status prior to conditioning did. Effective pathway inhibitor-based salvage therapies combined with NMA conditioning might thus represent the most attractive contemporary approach for alloHSCT for patients with CLL.

KW - Adult

KW - Aged

KW - Antineoplastic Combined Chemotherapy Protocols/therapeutic use

KW - Busulfan/administration & dosage

KW - Combined Modality Therapy

KW - Cyclophosphamide/administration & dosage

KW - Female

KW - Follow-Up Studies

KW - Graft vs Host Disease/epidemiology

KW - Hematopoietic Stem Cell Transplantation/mortality

KW - Humans

KW - Incidence

KW - Leukemia, Lymphocytic, Chronic, B-Cell/mortality

KW - Male

KW - Melphalan/administration & dosage

KW - Middle Aged

KW - Prognosis

KW - Remission Induction

KW - Retrospective Studies

KW - Survival Rate

KW - Transplantation Conditioning/mortality

KW - Transplantation, Homologous

KW - Young Adult

U2 - 10.1007/s00432-019-03014-x

DO - 10.1007/s00432-019-03014-x

M3 - Journal article

VL - 145

SP - 2823

EP - 2834

JO - European Journal of Cancer and Clinical Oncology

JF - European Journal of Cancer and Clinical Oncology

SN - 0171-5216

IS - 11

ER -

ID: 58987082