Abstract
To address limitations of the currently used reduced-intensity/myeloablative conditioning (RIC/MAC) classification scheme we aimed to develop a tool that can capture more standardized the conditioning intensity of allogeneic hematopoietic cell transplantation (HCT). We assigned intensity weight scores for frequently used conditioning regimen components and used their sum to generate the transplant conditioning intensity (TCI) score. We retrospectively tested the impact of TCI on 8255 adult (45–65 years) acute myeloid leukemia patients who underwent HCT in first complete remission. A Cox model for early nonrelapse mortality (NRM) yielded a 3-group TCI risk scheme (low, intermediate, high) with respective TCI scores of [1–2], [2.5–3.5] and [4–6]. On multivariate modeling, TCI grouping was highly and better predictive for early (day 100 and 180) NRM, 2-year NRM and relapse (REL) as compared with the RIC/MAC classification. Validation was done on 200 bootstrap samples. Moreover, TCI scoring enabled the identification of a distinct subgroup of RIC and MAC conditioning regimens with an intermediate TCI [2.5–3.5] score that had identical outcomes and which are frequently referred as “reduced toxicity conditioning”. TCI scheme provides an improvement of the RIC/MAC classification. We propose TCI as a new tool to define and measure the conditioning regimen intensity.
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Change history
06 March 2020
A Correction to this paper has been published: https://doi.org/10.1038/s41409-020-0835-3
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Acknowledgements
We thank Emmanuelle Polge and the ALWP EBMT staff for help with data management. The study was accomplished thanks to the contributing centers of the EBMT registry which provided patient data; a complete list appears in the Supplementary Appendix. Following EBMT publication rules, co-authorship was offered to centers contributing the highest number of patients.
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AS designed the study, performed research, analyzed data and wrote the paper; ML performed research, analyzed data and edited the paper; BNS, AN and MM designed the study, performed research and edited the paper; RN, DB, CC, GS, UP, DBe, NM, JJC, AG, AH and LG provided patient data and commented on the paper; SG, MA, EB, FM, JE, ZP, FB, AR, CS, MG, NCG, FL, RS, JV, GB, FC, JS and AB designed the study and commented on the paper.
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UP declared honoraria and research support by Celgene, Novartis, Amgen, Janssen. DB declared honoraria for consultancy and advisory board membership, travel support by medac GmbH, Wedel, Germany. The other authors have no disclosures related to the study.
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Spyridonidis, A., Labopin, M., Savani, B.N. et al. Redefining and measuring transplant conditioning intensity in current era: a study in acute myeloid leukemia patients. Bone Marrow Transplant 55, 1114–1125 (2020). https://doi.org/10.1038/s41409-020-0803-y
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DOI: https://doi.org/10.1038/s41409-020-0803-y
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