Reduced-intensity vs myeloablative conditioning allogeneic hematopoietic SCT for patients aged over 45 years with ALL in remission: A study from the adult ALL working group of the Japan Society for Hematopoietic Cell Transplantation (JSHCT)

J. Tanaka, H. Kanamori, S. Nishiwaki, K. Ohashi, S. Taniguchi, T. Eto, H. Nakamae, K. Minagawa, K. Miyamura, H. Sakamaki, Y. Morishima, K. Kato, R. Suzuki, N. Nishimoto, K. Oba, N. Masauzi

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Abstract

In this study, outcomes for 575 adult ALL patients aged ≥45 years who underwent first allo-SCT in CR were analyzed according to the type of conditioning regimen (myeloablative conditioning (MAC) for 369 patients vs reduced-intensity conditioning (RIC) for 206 patients). Patients in the RIC group were older (median age, 58 vs 51 years, P<0.0001). There were no statistically significant differences in 3-year OS, disease-free survival (DFS) and non-relapse mortality (NRM): 51% vs 53%, 47% vs 39% and 38% vs 36%, respectively. Multivariate analysis showed that CR2 and HLA mismatching were associated with poor OS (P=0.002 and P=0.019, respectively). HLA mismatching was associated with lower rate of relapse (P=0.016), but was associated with higher rate of NRM (P=0.001). RIC was associated with good OS and DFS in patients who received HLA-mismatch transplantation and were aged ≥55 years compared with MAC by multivariate analysis for each event with interaction (hazard ratio (HR) and 95% confidence interval 0.35 and 0.15-0.81, P=0.014 for OS and 0.36 and 0.16-0.81, P=0.013 for DFS). Therefore, patients ≥55 years of age with HLA-mismatch transplantation should be candidates for RIC rather than MAC.

Original languageEnglish (US)
Pages (from-to)1389-1394
Number of pages6
JournalBone Marrow Transplantation
Volume48
Issue number11
DOIs
StatePublished - Nov 1 2013

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Cell Transplantation
Japan
Disease-Free Survival
Multivariate Analysis
Transplantation
Mortality
Confidence Intervals
Recurrence

All Science Journal Classification (ASJC) codes

  • Hematology
  • Transplantation

Cite this

Tanaka, J. ; Kanamori, H. ; Nishiwaki, S. ; Ohashi, K. ; Taniguchi, S. ; Eto, T. ; Nakamae, H. ; Minagawa, K. ; Miyamura, K. ; Sakamaki, H. ; Morishima, Y. ; Kato, K. ; Suzuki, R. ; Nishimoto, N. ; Oba, K. ; Masauzi, N. / Reduced-intensity vs myeloablative conditioning allogeneic hematopoietic SCT for patients aged over 45 years with ALL in remission : A study from the adult ALL working group of the Japan Society for Hematopoietic Cell Transplantation (JSHCT). In: Bone Marrow Transplantation. 2013 ; Vol. 48, No. 11. pp. 1389-1394.
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title = "Reduced-intensity vs myeloablative conditioning allogeneic hematopoietic SCT for patients aged over 45 years with ALL in remission: A study from the adult ALL working group of the Japan Society for Hematopoietic Cell Transplantation (JSHCT)",
abstract = "In this study, outcomes for 575 adult ALL patients aged ≥45 years who underwent first allo-SCT in CR were analyzed according to the type of conditioning regimen (myeloablative conditioning (MAC) for 369 patients vs reduced-intensity conditioning (RIC) for 206 patients). Patients in the RIC group were older (median age, 58 vs 51 years, P<0.0001). There were no statistically significant differences in 3-year OS, disease-free survival (DFS) and non-relapse mortality (NRM): 51{\%} vs 53{\%}, 47{\%} vs 39{\%} and 38{\%} vs 36{\%}, respectively. Multivariate analysis showed that CR2 and HLA mismatching were associated with poor OS (P=0.002 and P=0.019, respectively). HLA mismatching was associated with lower rate of relapse (P=0.016), but was associated with higher rate of NRM (P=0.001). RIC was associated with good OS and DFS in patients who received HLA-mismatch transplantation and were aged ≥55 years compared with MAC by multivariate analysis for each event with interaction (hazard ratio (HR) and 95{\%} confidence interval 0.35 and 0.15-0.81, P=0.014 for OS and 0.36 and 0.16-0.81, P=0.013 for DFS). Therefore, patients ≥55 years of age with HLA-mismatch transplantation should be candidates for RIC rather than MAC.",
author = "J. Tanaka and H. Kanamori and S. Nishiwaki and K. Ohashi and S. Taniguchi and T. Eto and H. Nakamae and K. Minagawa and K. Miyamura and H. Sakamaki and Y. Morishima and K. Kato and R. Suzuki and N. Nishimoto and K. Oba and N. Masauzi",
year = "2013",
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doi = "10.1038/bmt.2013.68",
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Tanaka, J, Kanamori, H, Nishiwaki, S, Ohashi, K, Taniguchi, S, Eto, T, Nakamae, H, Minagawa, K, Miyamura, K, Sakamaki, H, Morishima, Y, Kato, K, Suzuki, R, Nishimoto, N, Oba, K & Masauzi, N 2013, 'Reduced-intensity vs myeloablative conditioning allogeneic hematopoietic SCT for patients aged over 45 years with ALL in remission: A study from the adult ALL working group of the Japan Society for Hematopoietic Cell Transplantation (JSHCT)', Bone Marrow Transplantation, vol. 48, no. 11, pp. 1389-1394. https://doi.org/10.1038/bmt.2013.68

Reduced-intensity vs myeloablative conditioning allogeneic hematopoietic SCT for patients aged over 45 years with ALL in remission : A study from the adult ALL working group of the Japan Society for Hematopoietic Cell Transplantation (JSHCT). / Tanaka, J.; Kanamori, H.; Nishiwaki, S.; Ohashi, K.; Taniguchi, S.; Eto, T.; Nakamae, H.; Minagawa, K.; Miyamura, K.; Sakamaki, H.; Morishima, Y.; Kato, K.; Suzuki, R.; Nishimoto, N.; Oba, K.; Masauzi, N.

In: Bone Marrow Transplantation, Vol. 48, No. 11, 01.11.2013, p. 1389-1394.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Reduced-intensity vs myeloablative conditioning allogeneic hematopoietic SCT for patients aged over 45 years with ALL in remission

T2 - A study from the adult ALL working group of the Japan Society for Hematopoietic Cell Transplantation (JSHCT)

AU - Tanaka, J.

AU - Kanamori, H.

AU - Nishiwaki, S.

AU - Ohashi, K.

AU - Taniguchi, S.

AU - Eto, T.

AU - Nakamae, H.

AU - Minagawa, K.

AU - Miyamura, K.

AU - Sakamaki, H.

AU - Morishima, Y.

AU - Kato, K.

AU - Suzuki, R.

AU - Nishimoto, N.

AU - Oba, K.

AU - Masauzi, N.

PY - 2013/11/1

Y1 - 2013/11/1

N2 - In this study, outcomes for 575 adult ALL patients aged ≥45 years who underwent first allo-SCT in CR were analyzed according to the type of conditioning regimen (myeloablative conditioning (MAC) for 369 patients vs reduced-intensity conditioning (RIC) for 206 patients). Patients in the RIC group were older (median age, 58 vs 51 years, P<0.0001). There were no statistically significant differences in 3-year OS, disease-free survival (DFS) and non-relapse mortality (NRM): 51% vs 53%, 47% vs 39% and 38% vs 36%, respectively. Multivariate analysis showed that CR2 and HLA mismatching were associated with poor OS (P=0.002 and P=0.019, respectively). HLA mismatching was associated with lower rate of relapse (P=0.016), but was associated with higher rate of NRM (P=0.001). RIC was associated with good OS and DFS in patients who received HLA-mismatch transplantation and were aged ≥55 years compared with MAC by multivariate analysis for each event with interaction (hazard ratio (HR) and 95% confidence interval 0.35 and 0.15-0.81, P=0.014 for OS and 0.36 and 0.16-0.81, P=0.013 for DFS). Therefore, patients ≥55 years of age with HLA-mismatch transplantation should be candidates for RIC rather than MAC.

AB - In this study, outcomes for 575 adult ALL patients aged ≥45 years who underwent first allo-SCT in CR were analyzed according to the type of conditioning regimen (myeloablative conditioning (MAC) for 369 patients vs reduced-intensity conditioning (RIC) for 206 patients). Patients in the RIC group were older (median age, 58 vs 51 years, P<0.0001). There were no statistically significant differences in 3-year OS, disease-free survival (DFS) and non-relapse mortality (NRM): 51% vs 53%, 47% vs 39% and 38% vs 36%, respectively. Multivariate analysis showed that CR2 and HLA mismatching were associated with poor OS (P=0.002 and P=0.019, respectively). HLA mismatching was associated with lower rate of relapse (P=0.016), but was associated with higher rate of NRM (P=0.001). RIC was associated with good OS and DFS in patients who received HLA-mismatch transplantation and were aged ≥55 years compared with MAC by multivariate analysis for each event with interaction (hazard ratio (HR) and 95% confidence interval 0.35 and 0.15-0.81, P=0.014 for OS and 0.36 and 0.16-0.81, P=0.013 for DFS). Therefore, patients ≥55 years of age with HLA-mismatch transplantation should be candidates for RIC rather than MAC.

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