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 Journal Article


Authors: Barba, P.; Martino, R.; Zhou, Q.; Cho, C.; Castro-Malaspina, H.; Devlin, S.; Esquirol, A.; Giralt, S.; Jakubowski, A. A.; Caballero, D.; Maloy, M.; Papadopoulos, E. B.; Piñana, J. L.; Fox, M. L.; Márquez-Malaver, F. J.; Valcárcel, D.; Solano, C.; López-Corral, L.; Sierra, J.; Perales, M. A.
Article Title: 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
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. © 2017 The American Society for Blood and Marrow Transplantation
Keywords: t cell depletion; gvhd; allogeneic hematopoietic cell transplantation; ric
Journal Title: Biology of Blood and Marrow Transplantation
Volume: 24
Issue: 5
ISSN: 1083-8791
Publisher: Elsevier Inc.  
Date Published: 2018-05-01
Start Page: 964
End Page: 972
Language: English
DOI: 10.1016/j.bbmt.2017.12.804
PROVIDER: scopus
PUBMED: 29305194
PMCID: PMC6800017
DOI/URL:
Notes: Article -- Export Date: 1 June 2018 -- Source: Scopus
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MSK Authors
  1. Sergio Andres Giralt
    759 Giralt
  2. Qin Zhou
    168 Zhou
  3. Miguel-Angel Perales
    593 Perales
  4. Molly Anna Maloy
    250 Maloy
  5. Sean McCarthy Devlin
    445 Devlin
  6. Christina Cho
    84 Cho