1. ¹Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
2. ²Hôpital Saint-Antoine, APHP and Université Pierre et Marie Curie, Paris, France
3. ³Institut Paoli Calmettes, Marseille, France
4. ⁴CHU Bordeaux Hôpital Haut-Lévèque, Pessac, France
5. ⁵Royal Marsden Hospital, London, UK
6. ⁶Hôpital E Herriot, Lyon, France
7. ⁷Kliniken Essen Süd, Essen, Germany
8. ⁸Cardarelli Hospital, Napoli, Italy
9. ⁹Hospital Clinic, Barcelona, Spain
10. ¹⁰Tor Vergata University Hospital, Rome, Italy
11. ¹¹Universitaetsklinikum Dresden, Dresden, Germany
12. ¹²Rambam Medical Center, Haifa, Israel
13. ¹³Heinrich Heine Universität, Klinik für Hämat, Düsseldorf, Germany
14. ¹⁴Medizinische Klinik und Poliklinik, Ulm, Germany
15. ¹⁵Hotel Dieu, Paris, France
16. ¹⁶Sahlgrenska University Hospital, Goeteborg, Sweden
17. ¹⁷Tel Aviv University, Chaim Sheba Medical Centre, Tel Hashomer, Israel
18. ¹⁸Hospital San Martino, Genova, Italy
19. ¹⁹Hôpital Saint-Louis, APHP, Paris, France

Correspondence: Dr V Rocha, Hôpital Saint-Louis, Service d'Hématologie-Greffe de Moelle, Trèfle 3, 1, avenue Claude Vellefaux, 75475 Paris Cedex 10, France. E-mail: vanderson.rocha@sls.ap-hop-paris.fr

Received 26 April 2006; Revised 6 September 2006; Accepted 27 September 2006; Published online 23 November 2006.

Abstract

We conducted a retrospective registry-based analysis to compare the outcome of 361 allogeneic human leukocyte antigen (HLA)-identical peripheral blood stem cell transplants (PBSCT) with reduced intensity conditioning (RIC) to that of 1369 autologous (auto) PBSCT in patients aged 50 years or older with de novo acute myeloid leukemia (AML), performed from 1997 until 2003 and reported to the European Group for Blood and Marrow Transplantation. Median age was 58 and 57 years in the RIC and auto groups, respectively. RIC patients had more advanced disease at the time of transplant. At a median follow-up of 24 months for RIC and 16 months for auto, multivariate analysis showed a lower risk for relapse (RR 0.77, P=0.013) without increased non-relapse mortality (NRM) in RIC patients (RR 1.26, P=0.28). Moreover, leukemia-free survival (RR 1.22, P=0.02) and overall survival (OS) (RR 1.32, P=0.005) were superior in the RIC group. In patients in 1st (CR), fewer relapses were counterbalanced by significantly increased NRM. Therefore, there was no survival advantage in this subgroup. In patients in 2nd or subsequent CR, LFS and OS were superior in the RIC group. RIC transplants show encouraging results in this older patient population with de novo AML.