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Long-term results of reduced-intensity conditioning allogeneic hematopoietic cell transplantation for older patients with acute myeloid leukemia: a retrospective analysis of 10-year follow-up data

Bone Marrow Transplantation volume 55, pages 2008–2016 (2020)Cite this article

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Abstract

The long-term outcomes of allogeneic hematopoietic cell transplantation (HCT) with reduced-intensity conditioning (RIC) remain inconclusive. To address this issue, we conducted a nationwide registry-based study of patients with acute myeloid leukemia (AML) age 50 years or older who underwent allogeneic HCT in complete remission using RIC (n = 284) or myeloablative conditioning (MAC, n = 190) between 2002 and 2007. The median follow-up period for surviving patients was 10.1 years for RIC recipients and 10.4 years for MAC recipients. The 10-year probabilities of overall survival, relapse, and non-relapse mortality were 36.4%, 30.0%, and 35.7% for RIC recipients, and 39.8%, 26.3%, and 35.5% for MAC recipients, respectively. Multivariate analysis revealed that the conditioning intensity did not affect overall mortality (P = 0.184), relapse (P = 0.904), or non-relapse mortality (P = 0.387). For the 218 patients qualifying for propensity score-matched pairing (109 pairs), RIC was found to be associated with similar survival (P = 0.095) and relapse (P = 0.467), and significantly lower non-relapse mortality (P = 0.046) compared with MAC. Our results confirm the long-term efficacy of RIC allogeneic HCT for older patients with AML and mitigate concerns over an increase in late relapse.

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Fig. 1: There were no differences between the groups in terms of overall survival, relapse, and non-relapse mortality.
Fig. 2: There were no differences between the groups in terms of overall survival and relapse, while the RIC group showed significantly lower non-relapse mortality than the MAC group.

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Acknowledgements

We thank Yoshihiro Inamoto of the National Cancer Center Hospital for providing statistical input. This work was supported in part by a grant from the Practical Research Project for Allergic Diseases and Immunology (Research Technology of Medical Transplantation) from the Japan Agency for Medical Research and Development (AMED), grant number: 18ek0510023h0002, and a grant from the Aichi Cancer Research Foundation, grant number: 2019-8.

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Authors and Affiliations

  1. Aichi Cancer Center, Nagoya, Japan

    Masamitsu Yanada

  2. National Cancer Center Hospital, Tokyo, Japan

    Takahiro Fukuda

  3. Kanagawa Cancer Center, Yokohama, Japan

    Masatsugu Tanaka

  4. Sapporo Hokuyu Hospital, Sapporo, Japan

    Shuichi Ota

  5. Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan

    Takashi Toya

  6. Keio University School of Medicine, Tokyo, Japan

    Takehiko Mori

  7. Toranomon Hospital, Tokyo, Japan

    Naoyuki Uchida

  8. Japanese Red Cross Nagoya First Hospital, Nagoya, Japan

    Yukiyasu Ozawa

  9. Graduate School of Medicine, Osaka City University, Osaka, Japan

    Hirohisa Nakamae

  10. Jichi Medical University, Shimotsuke, Japan

    Yoshinobu Kanda

  11. Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan

    Tatsuo Ichinohe

  12. Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan

    Yoshiko Atsuta

  13. Nagoya University Graduate School of Medicine, Nagoya, Japan

    Yoshiko Atsuta

  14. The Jikei University School of Medicine, Tokyo, Japan

    Shingo Yano

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  1. Masamitsu Yanada
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Correspondence to Masamitsu Yanada.

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Yanada, M., Fukuda, T., Tanaka, M. et al. Long-term results of reduced-intensity conditioning allogeneic hematopoietic cell transplantation for older patients with acute myeloid leukemia: a retrospective analysis of 10-year follow-up data. Bone Marrow Transplant 55, 2008–2016 (2020). https://doi.org/10.1038/s41409-020-0868-7

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