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Acute Leukemia

Conditioning intensity in middle-aged patients with AML in first CR: no advantage for myeloablative regimens irrespective of the risk group–an observational analysis by the Acute Leukemia Working Party of the EBMT

Bone Marrow Transplantation volume 50, pages 1063–1068 (2015)Cite this article

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Abstract

In recipients of allogeneic hematopoietic stem cell transplantation with AML in CR1, reduced intensity (RIC) conditioning regimens are usually given to older patients and myeloablative regimens (MAC) to younger patients. We analyzed whether in middle-aged patients aged 40–60 years, MAC was superior to RIC in cytogenetically higher risk AML. Among 2974 patients, 1638 had MAC and 1336 RIC transplants. Cytogenetics were high risk in 508, intermediate risk in 2297 and low risk in 169. Overall survival (OS) was higher in patients with RIC with low-risk cytogenetics but not in the intermediate- or poor-risk AML. Relapse incidence was lower with MAC in poor- and intermediate-risk AML. Nonrelapse mortality (NRM) was higher in MAC in all cytogenetic risk groups. Multivariate analysis confirmed a significant leukemia-free survival and OS advantage for RIC in low risk but no advantage of MAC in intermediate- and poor-risk leukemia. In patients aged 40–60 years, MAC has no advantage over RIC. We confirm lower relapse but higher NRM risks with MAC. MAC is not superior in patients with higher risk cytogenetics, but is inferior to RIC in the small cohort of AML patients with low-risk cytogenetics.

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Acknowledgements

We acknowledge the many centers, data managers and patients who contributed data to make this analysis possible. MM thanks Pr JV de Melo (University of Adelaide, Australia) for critical reading of the manuscript.

Author information

Author notes

  1. A Nagler and M Mohty: These authors contributed equally to this work.

  2. Members of the Acute Leukemia Working Party of the European Blood and Marrow Transplant Group (EBMT) are listed before References.

Authors and Affiliations

  1. Division of Hematology, University Hospital Basel, Basel, Switzerland,

    J R Passweg

  2. EBMT Paris Study Office, Paris, France

    M Labopin

  3. Erasmus MC-Daniel den Hoed Cancer Centre, Rotterdam, The Netherlands

    J Cornelissen

  4. Stem Cell Transplantation Unit, Comprehensive Cancer Center, Helsinki University Hospital, Helsinki, Finland

    L Volin

  5. Division of Hematology, Hospital St Louis & University Paris, Paris, France

    G Socié

  6. CHU Department Hematologie, Hopital de Purpan, Toulouse, France

    A Huynh

  7. CHU Bordeaux, Hôpital Haut-leveque, Pessac, France

    R Tabrizi

  8. Department of Hematology, First Affiliated Hospital of Soochow University, Suzhou, China

    D Wu

  9. Centre for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, UK

    C Craddock

  10. Department of Hematology, Nijmegen Medical Centre, Radboud University, Nijmegen, The Netherlands

    N Schaap

  11. Department of Hematology, University Medical Center Utrecht, Utrecht, The Netherlands

    J Kuball

  12. Department D'Hematologie, CHU Nantes, Nantes, France

    P Chevallier

  13. Clinique Universitaire d'Hématologie CHU Grenoble, Grenoble, France

    J Y Cahn

  14. Département D'Onco-Hématologie, Institut Paoli Calmettes, Marseille, France

    D Blaise

  15. Hematology-Oncology and BMT Research, Shariati Hospital, Teheran, Iran

    A Ghavamzadeh

  16. CHU Hautepierre—Service d'Onco Hematologie, Strasbourg, France

    K Bilger

  17. Ospedale San Raffaele, Milano, Italy

    F Ciceri

  18. Medizinische Klinik II, Klinikum Augsburg, Augsburg, Germany

    C Schmid

  19. Department of Bone Marrow Transplantation and Hematology-Oncology, Maria Sklodowska-Curie Memorial Cancer Center, Gliwice, Poland

    S Giebel

  20. Hematology Division, Chaim Sheba Medical Center, Tel-Hashomer, Israel

    A Nagler

  21. Department of Hematology, Hospital Saint Antoine, Paris, France

    M Mohty

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  1. J R Passweg
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Consortia

Acute Leukemia Working Party of the European Blood and Marrow Transplant Group (EBMT)

Corresponding author

Correspondence to J R Passweg.

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The authors declare no conflict of interest.

Additional information

This study was presented in part at the American Society of Hematology meeting in December 2013

Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland; Department of Hematology—BMT, Hopital St Louis, Paris, France; Department of Hematologie, Hopital Purpan-CHU de Toulouse, Toulouse, France; Erasmus MC-Daniel den Hoed Cancer Centre, Rotterdam, The Netherlands; CHU Bordeaux, Pessac, France; Department of Hematology, First Affiliated Hospital of Soochow University, Suzhou, China; Centre for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, UK; University Medical Center St Radboud, Nijmegen, The Netherlands; University Medical Centre, Utrecht, The Netherlands; Department of D'Hematologie, CHU Nantes, Nantes, France; Hopital A. Michallon—Hématologie Clinique—Pole Cancérologie, Grenoble, France; Programme de Transplantation&Therapie Cellulaire, Centre de Recherche en Cancérologie de Marseille, Institut Paoli Calmettes, Marseille, France; Hematology-Oncology and BMT Research, Shariati Hospital, Teheran, Iran; Service d'Onco Hematologie, CHU Hautepierre, Strasbourg, France; Service d'Hématologie, Hopital Jean Minjoz, Besancon, France; University Hospital Gasthuisberg, Leuven, Belgium; University Hospital, Basel, Switzerland; Hôpital HURIEZ—UAM allo-CSH—CHRU, Lille, France; Centre Hospitalier Lyon Sud—Service Hematologie, Lyon, France; Gustave Roussy, institut de cancérologie—BMT Service, Division of Hematology -Department of Medical Oncology, Villejuif, France; Leiden University Hospital, Leiden, The Netherlands; Hospital U. Marqués de Valdecilla, Santander, Spain; Hopital Saint Antoine, Paris, France; Department of Hematology, Karolinska University Hospital, Huddinge, Sweden; Hannover Medical University, Hannover, Germany; CHRU, Service des Maladies du Sang, Angers, France; Department of Hematology/Oncology, Charles University Hospital, Pilsen, Czech Republic; University Medical Center Groningen (UMCG), Groningen, The Netherlands; Nottingham City Hospital, Nottingham, UK; Hopital La Miletrie, Poitiers, France; UnitT de Transplantation Médullaire, Vandoeuvre les Nancy, France; Département d'Hématologie Clinique, CHU Lapeyronie, Montpellier, France; Rigshospitalet—BMT Unit Department of Hematology L 4042, Copenhagen, Denmark; University Hospital, Lund, Sweden; Deutsche Klinik für Diagnostik—KMT Zentrum, Wiesbaden, Germany; Department of Stem cell Transplantation, University Hospital Eppendorf, Hamburg, Germany; Department of Haematology and Stem Cell Transplant, Budapest, Hungary; Medizinische Klinik und Poliklinik, Ulm, Germany; Rome Transplant Network—‘Tor Vergata’ University of Rome—Stem Cell Transplant Unit-Policlinico Universitario Tor Vergata, Rome, Italy; Universitaetsklinikum Dresden, Dresden, Germany; Azienda Ospedaliera Papa Giovanni XXIII—Hematology and Bone Marrow Transplant Unit, Bergamo, Italy; Hôpital Necker, Paris, France; University Hospital, Linköping, Sweden; Department of Medicine-Hematology, Oncology, University of Freiburg, Freiburg, Germany; Cliniques Universitaires St Luc, Brussels, Belgium; King Faisal Specialist Hospital & Research Centre Oncology (Section of Adult Haematolgy/BMT), Riyadh, Saudi Arabia; Klinikum Nürnberg, Nürnberg, Germany; University Hospital Maastricht, Maastricht, The Netherlands; University of Liege, Liege, Belgium; Royal Victoria Infirmary, Newcastle-Upon-Tyne, UK; Leicester Royal Infirmary, Leicester, UK; Hospital Clínico, Salamanca, Spain; Centre Henri Becquerel, Rouen, France; Centre Hospitalier Universitaire, Caen, France; Department of Haematology, Oxford, UK; Hopitaux Universitaires de Geneve, Geneva, Switzerland; Hopsital Pitie-Salpetriere, Paris, France; Hôpital Henri Mondor, Creteil, France; St James Hospital Trinity College, Dublin, Ireland; Sahlgrenska University Hospital, Goeteborg, Sweden; Addenbrookes Hospital, Cambridge, UK; Turku University, Turku, Finland; VU University Medical Center, Amsterdam, The Netherlands; CHU Morvan, Brest, France; Department of Oncologico, Ospedale La Maddalena, Palermo, Italy; Hospital Santa Creu i Sant Pau, Barcelona, Spain; Ospedale San Gerardo, Monza, Italy; Universita degli Studi di Bari, Bari, Italy; University College London Hospital, London, UK; Azienda Ospedaliera S. Giovanni, Torino, Italy; Ospedale di Careggi, Firenze, Italy; Centre Hospitalier Universitaire de Rennes, Rennes, France; Hôpital Percy, Clamart, France; Institute of Portugues de Oncologia do Porto, Porto, Portugal; North Trent BMT Programme (Adults), Sheffield, UK; University of Saarland, Homburg, Germany; Charité Universitätsmedizin Berlin, Berlin, Germany; Hopital Nord, Saint Etienne Cedex 2, France; Department of Bone Marrow Transplantation, University Hospital, Essen, Germany; Hospital Universitari Germans Trias i Pujol, Barcelona, Spain; Umea University Hospital, Umeå, Sweden; Imperial College, London, UK; Bologna University, S.Orsola-Malpighi Hospital, Bologna, Italy; University Hospital, Olomouc, Czech Republic; Hospital Universitario La Fe, Valencia, Spain; Southampton General Hospital, Southampton, UK; Division of Hematology, Federico II' Medical School, University of Napoli, Napoli, Italy; Constantiaberg Medi-Clinic, Cape Town, South Africa; Institut Jules Bordet, Brussels, Belgium; Belfast City Hospital, Belfast, UK; Royal Marsden Hospital, London, UK; University of'La Sapienza', Rome, Italy; Rikshospitalet, Department of Medicine, The National Hospital, Oslo, Norway; Institute of Hematology and Blood Transfusion, Prague, Czech Republic; Tel Aviv University, Tel-Hashomer, Israel; ICO—Hospital Duran i Reynals, Barcelona, Spain; Klinikum Augsburg—II Medizinische Klinik, Augsburg, Germany; Policlinico G.B. Rossi, Verona, Italy; Ospedale Ferrarotto, Catania, Italy; Canterbury Health Laboratories, Christchurch, New Zealand; H SS. Antonio e Biagio, Alessandria, Italy; Antwerp University Hospital (UZA), Antwerp Edegem, Belgium; Haematology Department, Leeds, UK; Ospedale Maggiore di Milano, Milano, Italy; Fédération de Greffe de Moelle et de, Clermont-Ferrand, France; Policlinico San Matteo, Pavia, Italy; Royal Liverpool University Hospital, Liverpool, UK; Hôpital de l'ARCHET I, Nice, France; Manchester Royal Infirmary, Manchester, UK; University Hospital, Zürich, Switzerland; University Hospital Leipzig, Leipzig, Germany; Department of Haematological Medicine, GKT School of Medicine, London, UK; University Regensburg, Regensburg, Germany; Ospedale San Raffaele s.r.l., Milano, Italy; Military Medical Academy, Warsaw, Poland; Robert-Bosch-Krankenhaus, Stuttgart, Germany; Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Gazi Universitesi Tip Fakültesi, Ankara, Turkey; Ospedale San Martino—Department of Haematology II, Genova, Italy; Glasgow Royal Infirmary, Glasgow, UK; Hadassah University Hospital, Jerusalem, Israel; University of Est. de Campinas/TMO/UNICAMP, Campinas, Brazil; University of Heidelberg—Medizinische Klinik u. Poliklinik V, Heidelberg, Germany; Hospital Vall d'Hebron, Barcelona, Spain; Professor Dr Axel A. Fauser—Klinik für Knochenmarktransplantation, Hämatologie und Onkologie; Idar-Oberstein, Germany; Silesian Medical Academy, Katowice, Poland; Institute of Haematology and Blood Transfusion, Warsaw, Poland; Christie NHS Trust Hospital, Manchester, UK; CHRU Limoges, Limoges, France; Hospital Clinic, Barcelona, Spain; University of Wales, Cardiff, UK; Universita Cattolica S. Cuore, Rome, Italy; Medical University Graz, Graz, Austria; Makassed University Hospital, Beirut, Lebanon; Haematology Department/BMT Unit, George Papanicolaou General Hospital, Thessaloniki, Greece; University Hospital Brno, Brno, Czech Republic; University Hospital VUB, Brussels, Belgium; Azienda Ospedali Riuniti di Ancona, Ancona-Torrete, Italy; Plymouth Hospitals NHS Trust, Plymouth, UK; Hospital Guglielmo da Saliceto, Piacenza, Italy; Hacettepe University, Ankara, Turkey; Hosp. Reina Sofia, Córdoba, Spain; Academisch Ziekenhuis bij de Universiteit, Amsterdam, The Netherlands; University Hospital, Uppsala, Sweden; Bristol Royal Hospital for Children, Bristol, UK; Beilinson Hospital, Petach-Tikva, Israel; A.Z. Sint-Jan, Brugge, Belgium; Ernst-Moritz-Arndt-University of Greifswald, Greifswald, Germany; King Hussein Cancer Centre, Amman, Jordan; Hospital Aranzazu, San Sebastian, Spain; University of Milano, Milano, Italy; Adult Stem Cell Transplantation Unit, Department of Hematology, Ankara University Faculty of Medicine, Ankara, Turkey; Vilnius University Hospital 'Santariskiu Klinikos', Vilnius, Lithuania; SPb State I. Pavlov Medical University, St Petersburg, Russia; Clinica Puerta de Hierro, Madrid, Spain; University Hospital Gent, Gent, Belgium; St Bartholomew's and The Royal London Hospital, London, UK; Centre National de Greffe de Moelle, Tunis, Tunisia; Royal Free Hospital and School of Medicine, London, UK; Hopital Bretonneau, Tours, France; Institute of Portugues Oncologia, Lisboa, Portugal; Department of Hematology, Rambam Health Care Campus, Haifa, Israel; DCTK, Wroclaw, Poland; Azienda Ospedaliera, Reggio Calabria, Italy; Az. Ospedaliera S. Croce e Carle, Cuneo, Italy; Hospital Covadonga, Oviedo, Spain; Tartu University Hospital, Tartu, Estonia; St Savas Oncology Hospital, Athens, Greece; Medical University of Gdansk, Gdansk, Poland; AZ. Spedali Civili-Brescia Universitu of Brescia, Brescia, Italy; Medizinische Universitaet Wien, Vienna, Austria; Western General Hospital, Edinburgh, UK; Ospedale Civile, Pescara, Italy; Hospital Clínico Universitario, Valencia, Spain; Birmingham Heartlands Hospital, Birmingham, UK; Klinikum Karlsruhe GmbH, Karlsruhe, Germany; Hospital San Maurizio, Bolzano, Italy; University Hospital Center Rebro, Zagreb, Croatia; Hospedale Nord, Taranto, Italy; St George’s Hospital, London, UK; Evangelismos Hospital, Athens, Greece; University Medical Center, Ljubljana, Slovenia; Department of Hematology/Oncology, University of Münster, Münster, Germany; Centre Pierre et Marie Curie—Service Hématologie Greffe de Moëlle, Alger, Algeria; Allogeneic Stem Cell Transplant Center, Würzburg, Germany; Charles University Hospital, Hradec Králové, Czech Republic; Johannes-Gutenberg-University, Mainz, Germany; Hospital Gregorio Marañón, Madrid, Spain; Mazzoni Hospital, Ascoli Piceno, Italy; Hospital de la Princesa, Madrid, Spain; Division of Stem Cell Transplantation and Immunotherapy, Kiel, Germany; The Trustee of London Clinic, London, UK; Ospedale di Niguarda Ca’ Granda, Milano, Italy; University of Torino, Torino, Italy; Policlinico Le Scotte, Siena, Italy; ZNA, Antwerp, Belgium; NHS Grampian, Aberdeen, UK; Istituto Clinico Humanitas, Milano, Italy; Ospedale V. Cervello, Palermo, Italy; Gaziantep University Medical School, Gaziantep, Turkey; Ankara Bayindir Hospital, Haematology BMT, Ankara, Turkey; Albert Albert's Stem Cell Transplantation Centre-Haematology Pretoria East Hospital, Pretoria Gauteng, South Africa; Department of Medicine, University of Cologne, Cologne, Germany; Military Medical Academy, Belgrade, Serbia and Montenegro; Klinikum Bremen Mitte, Bremen, Germany; Cardarelli Hospital, Napoli, Italy; Ege University Medical School, Bornova-Izmir, Turkey; Hospital Universitario Son Espases, Palma De Mallorca, Spain; Unità Operativa Oncoematologia Pediatrica, Pisa, Italy; S. Bortolo Hospital, Vicenza, Italy; P.O. 'R. Binaghi, Cagliari, Italy; Stem Cell Transplant Unit, Medical Park Hospitals, Antalya, Turkey; Central Clinical Hospital, Warsaw, Poland.

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Passweg, J., Labopin, M., Cornelissen, J. et al. Conditioning intensity in middle-aged patients with AML in first CR: no advantage for myeloablative regimens irrespective of the risk group–an observational analysis by the Acute Leukemia Working Party of the EBMT. Bone Marrow Transplant 50, 1063–1068 (2015). https://doi.org/10.1038/bmt.2015.121

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