This study shows the long-term updated outcomes of a multicenter retrospective study which analyzed 843 patients with myelodysplastic syndrome (MDS) who underwent transplantation with an HLA-identical sibling donor with either reduced-intensity conditioning (RIC) in 213 patients, or standard myeloablative conditioning (MAC) in 630 patients. In multivariate analysis, the 13-year relapse rate was significantly increased after RIC (31% after MAC vs 48% in RIC; HR, 1.5; 95% CI, 1.1-1.9; P=0.04), but with no differences in overall survival (OS) (30% after MAC vs 27% in RIC; P=0.4) and PFS (29 vs 21%, respectively, P=0.3). Non-relapse mortality was higher in MAC (40 vs 31%; P=0.1), especially in patients older than 50 years (50 vs 33%, P<0.01). In addition, long-term follow-up confirms the importance of other variables on 13-year OS, mainly MDS risk category, disease phase, cytogenetics and receiving a high donor cell dose, irrespective of the conditioning regimen used.
- MeSH
- analýza přežití MeSH
- dárci tkání MeSH
- lidé středního věku MeSH
- lidé MeSH
- myelodysplastické syndromy mortalita terapie MeSH
- následné studie MeSH
- příprava pacienta k transplantaci metody mortalita MeSH
- retrospektivní studie MeSH
- senioři MeSH
- sourozenci MeSH
- studie případů a kontrol MeSH
- testování histokompatibility MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- senioři MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
The impact of in vivo T-cell depletion on transplantation outcomes in patients transplanted with reduced-intensity conditioning (RIC) remains controversial. This study assessed the outcome of 1250 adult patients with de novo AML in first CR (CR1) given PBSC from HLA-identical siblings after chemotherapy-based RIC. A total of 554 patients did not receive any form of in vivo T-cell depletion (control group), whereas antithymocyte globulin (ATG) and alemtuzumab were given in 444 and 252 patients, respectively. The incidences of grade II-IV acute GVHD were 21.4, 17.6 and 10.2% in control, ATG and alemtuzumab patients, respectively (P<0.001). In multivariate analysis, the use of ATG and the use of alemtuzumab were each associated with a lower risk of chronic GVHD (P<0.001 each), but a similar risk of relapse, and of nonrelapse mortality, and similar leukemia-free survival and OS. Further, among patients given BU-based RIC, the use of <6 mg/kg ATG did not increase the risk of relapse (hazard ratio, HR=1.1), whereas there was a suggestion for higher relapse risk in patients given 6 mg/kg ATG (HR=1.4, P=0.08). In summary, these data suggest that a certain amount of in vivo T-cell depletion can be safely used in the conditioning of AML patients in CR1 given PBSC after chemotherapy-based RIC.
- MeSH
- akutní myeloidní leukemie krev terapie MeSH
- antilymfocytární sérum metabolismus MeSH
- dárci tkání MeSH
- dospělí MeSH
- HLA antigeny imunologie MeSH
- homologní transplantace MeSH
- humanizované monoklonální protilátky terapeutické užití MeSH
- incidence MeSH
- indukce remise MeSH
- kmenové buňky cytologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- melfalan terapeutické užití MeSH
- mladý dospělý MeSH
- multivariační analýza MeSH
- nemoc štěpu proti hostiteli MeSH
- přežití bez známek nemoci MeSH
- příprava pacienta k transplantaci metody MeSH
- proporcionální rizikové modely MeSH
- recidiva MeSH
- retrospektivní studie MeSH
- senioři MeSH
- sourozenci MeSH
- T-lymfocyty cytologie MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- Geografické názvy
- Evropa MeSH
