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Allografting

Comparison between reduced intensity and conventional myeloablative allogeneic stem-cell transplantation in patients with hematologic malignancies aged between 50 and 59 years

Bone Marrow Transplantation volume 36, pages 667–674 (2005)Cite this article

Summary:

To evaluate the efficacy of reduced-intensity stem-cell transplantation (RIST), we retrospectively compared outcomes of 207 consecutive Japanese patients aged between 50 and 59 years with hematologic malignancies who received RIST (n=70) and conventional stem-cell transplantation (CST) (n=137). CST recipients received total body irradiation (TBI)-based or busulfan/cyclophosphamide-based regimens. RIST regimens were purine analog-based (n=67), 2 Gy TBI-based (n=2), and others (n=1). Most CST recipients (129/137) received calcineurin inhibitors and methotrexate as graft-versus-host (GVHD) prophylaxis, while 32 RIST recipients received cyclosporin. In all, 23 CST and five RIST recipients died without disease progression within 100 days of transplant. Grade II to IV acute GVHD occurred in 56 CST and 38 RIST recipients. There was no significant difference in overall survival (OS) and progression-free survival between CST and RIST. On multivariate analysis on OS, five variables were significant: preparative regimens (CST vs RIST) (hazard ratio=1.92, 95% confidence interval, 1.25–2.97; P=0.003), performance status (2–4 vs 0–1) (2.50, 1.51–4.16; P<0.001), risk of underlying diseases (1.85, 1.21–2.83; P=0.004), acute GVHD (2.57, 1.72–3.84; P<0.001), and CML (0.38, 0.21–0.69; P=0.002). We should be careful in interpreting results of this small-sized retrospective study; however, reduced regimen-related toxicity might contribute to better survival in RIST. The low relapse rates following RIST suggest a strong antitumor activity through allogeneic immunity.

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Acknowledgements

This study was supported by a Grant-in-aid of the Ministry of Labor and Welfare in Japan. We thank T Fukuda for scientific discussions and for critically reviewing the manuscript. We thank all the staff and resident members of the transplant centers in Japan. A complete list of participating institutions appears in the Appendix.

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Author notes

  1. H Hirai: Hisamaru Hirai died in August 2003.

Authors and Affiliations

  1. Hematopoietic Stem Cell Transplantation Unit, the National Cancer Center Hospital, Tokyo, Japan

    R Kojima, M Kami, Y Kishi, S-i Mori, K Tajima & Y Takaue

  2. Department of Cell Therapy & Transplantation Medicine, University of Tokyo, Tokyo, Japan

    Y Kanda & H Hirai

  3. Department of Hematology, Toranomon Hospital, Tokyo, Japan

    E Kusumi & S Taniguchi

  4. Hematology Division, Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan

    Y Tanaka & H Sakamaki

  5. Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan

    S Yoshioka & T Ichinohe

  6. Department of Hematology, Meitetsu Hospital, Nagoya, Japan

    S Morishima

  7. First Department of Internal Medicine, Yokohama City University School of Medicine, Yokohama, Japan

    S Fujisawa

  8. Department of Hematology, Sapporo Hokuyu Hospital, Hokkaido, Japan

    M Kasai

  9. Department of Internal Medicine, Rinku General Medical Center, Osaka, Japan

    K Hatanaka

  10. Department of Internal Medicine, Japanese Red Cross Nagoya First Hospital, Aichi, Japan

    M Kasai

  11. Department of Hematology, Dokkyo University School of Medicine, Tochigi, Japan

    K Mitani

  12. Medicine and Biosystemic Science, Kyusyu University Graduate School of Medical Sciences, Fukuoka, Japan

    M Harada

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  1. R Kojima
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  2. M Kami
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  7. S Yoshioka
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  8. S Morishima
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  9. S Fujisawa
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  16. T Ichinohe
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  17. H Hirai
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  18. S Taniguchi
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  19. H Sakamaki
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  20. M Harada
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Corresponding author

Correspondence to M Kami.

Appendix

Appendix

This study was conducted at the following institutions under the auspices of the following investigators in Japan: Tanimoto E Tetsuya (Kyusyu University Graduate School of Medical Sciences, Fukuoka), Iida H (Meitetsu Hospital, Aichi), Matsue K (Kameda General Hospital, Chiba), Kato K (Hamanomachi Hospital, Fukuoka), Shinagawa K (Okayama University Medical School, Okayama), Abe Y (Kyusyu University Graduate School of Medical Sciences, Fukuoka), Nakajyo T (Kanazawa University Graduate School of Medicine, Kanazawa), Uike N (National Kyushu Cancer Center, Fukuoka), Okamoto S (Keio University School of Medicine, Tokyo), Hirabayashi N (Nagoya Daini Red Cross Hospital, Aichi), Komatsu T (Tsukuba Memorial Hospital, Ibaraki), Tamaki S (Yamada Red Cross Hospital, Mie), Izumi Y (Kokura Memorial Hospital, Fukuoka), Karasuno T (Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka), Yamane T (Osaka City University, Osaka), Ashida T (Kinki University Hospital, Osaka), Wakita A (Nagoya City University Graduate School of Medical Science, Aichi), Furukawa T (Niigata Uniersity Medical Hospital, Niigata), Teshima H (Osaka City General Hospital, Osaka), Yamashita T (National Defense Medical College Hospital, Saitama), Miyazaki Y (Kansai Medical University Hospital, Osaka), Kobayashi Y & Taniwaki M (Kyoto Prefectural University of Medicine, Kyoto), Kobayashi H (Nagano Red Cross Hospital, Nagano), Ito T (Nihon University School of Medicine, Tokyo), Ishida Y (Iwate Medical University Hospital, Iwate), Yoshihara S (Osaka University Graduate School of Medicine, Osaka), Ri M (Shizuoka Saiseikai General Hospital, Shizuoka), Fukushima N (Saga Medical School, Saga), Iwashige A (University of Occupational and Environmental Health, Fukuoka), Togitani K (Kochi Medical School, Kochi), Yamamoto Y (Kishiwada City Hospital, Osaka), Otsuka E (Oita Medical University, Oita), Fujiyama Y (Shiga University of Medical Science, Shiga), Hirokawa M (Akita University School of Medicine, Akita), Nishimura M (Chiba University Graduate School of Medicine, Chiba), Imamura S (Fukui Medical University, Fukui), Masauzi N (Hakodate Municipal Hospital, Hokkaido), Hara M (Ehime Prefectural Central Hospital, Ehime), Moriuchi Y (Sasebo City General Hospital, Nagasaki), Hamaguchi M (Nagoya National Hospital, Aichi), Nishiwaki K (The JikeiUniversity School of Medicine, Tokyo), Yokota A (Chiba Municipal Hospital, Chiba), Takamatsu Y (Fukuoka University School of Medicine, Fukuoka).

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Kojima, R., Kami, M., Kanda, Y. et al. Comparison between reduced intensity and conventional myeloablative allogeneic stem-cell transplantation in patients with hematologic malignancies aged between 50 and 59 years. Bone Marrow Transplant 36, 667–674 (2005). https://doi.org/10.1038/sj.bmt.1705122

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