PMID- 15654906
OWN - NLM
STAT- MEDLINE
DCOM- 20050323
LR  - 20061115
IS  - 0902-4441 (Print)
IS  - 0902-4441 (Linking)
VI  - 74
IP  - 2
DP  - 2005 Feb
TI  - Conventional versus reduced-intensity conditioning regimen for allogeneic stem 
      cell transplantation in patients with hematological malignancies.
PG  - 144-51
AB  - BACKGROUND: Allogeneic hematopoietic stem cell transplantation (HSCT) from human 
      leukocyte antigen (HLA)-compatible sibling donors is a potential curative 
      treatment for hematological and non-hematological malignancies. Nevertheless, 
      high mortality rates may be associated with this therapy, especially in older 
      patients, those with other comorbidities or who receive a second HSCT. PATIENTS 
      AND METHODS: We analyzed the factors associated with transplant-related mortality 
      (TRM) and overall survival in 157 consecutive adult patients (104 males and 53 
      females) who received a HSCT [29 bone marrow (BM) transplantation and 128 
      peripheral blood (PB) transplantation] from a HLA-identical sibling between 
      January 1995 and March 2002 in our institution. One hundred patients received a 
      standard conditioning prior to HSCT (STAND) and 57 patients received a 
      reduced-intensity conditioning (RIC) HSCT. Fifty-eight patients were in an early 
      phase at transplant and 99 in a non-early phase. Median age was 46 yr (16-66), 
      and 90 patients (57%) were >45 yr of age. RESULTS: Patients in the RIC group were 
      older than those in the STAND group, and had a higher proportion of non-early 
      disease phases including a prior autologous HSCT in 39%. Median follow-up for 
      survivors was 28 and 15 months in the STAND and RIC groups (P < 0,001), 
      respectively. Cumulative incidence of TRM at 2 yr was 30% [95% confidence 
      interval (CI) 22-41%] for the STAND group and 22% (95% CI 13-37%) for the RIC 
      group [non-significant (NS)]. Factors associated with a higher TRM in 
      multivariate analysis were: STAND vs. RIC conditioning regimen [relative risk 
      (RR) 5.4; 95% CI 2.3-12.8; P < 0.001]; age > or =45 yr vs. <45 yr (RR 5; 95% CI 
      2.4-10.8, P < 0.001); second vs. first HSCT (RR 2.8, 95% CI 1.3-6.3, P = 0.01) 
      and non-T-cell-depleted vs. T-cell-depleted graft (RR 2.7, 95% CI 1.3-5.8, P = 
      0.009). Overall survival (OS) at 2 yr was 52.5 +/- 10.4% for STAND group and 59 
      +/- 16.8% in RIC group. Factors associated with poorer OS in multivariate 
      analysis were: STAND vs. RIC conditioning regimen (RR 3.4, 95% CI 1.7-6.9, P = 
      0.001); age > or =45 vs <45 yr (RR 2.5, 95% CI 1.4-4.5, P = 0.002) and diagnosis 
      [other than chronic myeloid leukemia (CML) vs. CML] (RR 2.6, 95% CI 1.2-5.7 P = 
      0.02). CONCLUSIONS: Our results indicate that the introduction of RIC allogeneic 
      HSCT for patients at high risk for TRM (advanced age, prior HSCT and non-T-cell 
      depletion) leads to a reduction in the TRM and improvement in the OS.
CI  - (c) Blackwell Munksgaard 2005
FAU - Valcarcel, D
AU  - Valcarcel D
AD  - Hospital de la Santa Creu i Sant Pau, Universitat Autonoma de Barcelona, 
      Barcelona, Spain.
FAU - Martino, R
AU  - Martino R
FAU - Sureda, A
AU  - Sureda A
FAU - Canals, C
AU  - Canals C
FAU - Altes, A
AU  - Altes A
FAU - Briones, J
AU  - Briones J
FAU - Sanz, M A
AU  - Sanz MA
FAU - Parody, R
AU  - Parody R
FAU - Constans, M
AU  - Constans M
FAU - Villela, S L
AU  - Villela SL
FAU - Brunet, S
AU  - Brunet S
FAU - Sierra, J
AU  - Sierra J
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - England
TA  - Eur J Haematol
JT  - European journal of haematology
JID - 8703985
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Age Factors
MH  - Aged
MH  - *Bone Marrow Transplantation/mortality/statistics & numerical data
MH  - Disease-Free Survival
MH  - Female
MH  - Hematologic Neoplasms/*therapy
MH  - *Hematopoietic Stem Cell Transplantation/mortality/statistics & numerical data
MH  - Humans
MH  - Lymphocyte Depletion/methods/statistics & numerical data
MH  - Middle Aged
MH  - Multivariate Analysis
MH  - Risk Factors
MH  - Transplantation Conditioning/*methods/mortality/*statistics & numerical data
MH  - Transplantation, Autologous
MH  - Transplantation, Homologous
EDAT- 2005/01/19 09:00
MHDA- 2005/03/24 09:00
CRDT- 2005/01/19 09:00
PHST- 2005/01/19 09:00 [pubmed]
PHST- 2005/03/24 09:00 [medline]
PHST- 2005/01/19 09:00 [entrez]
AID - EJH360 [pii]
AID - 10.1111/j.1600-0609.2004.00360.x [doi]
PST - ppublish
SO  - Eur J Haematol. 2005 Feb;74(2):144-51. doi: 10.1111/j.1600-0609.2004.00360.x.