Originally published as JCO Early Release 10.1200/JCO.2008.20.9692 on August 3 2009

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Reduced Intensity Conditioning Compared With Myeloablative Conditioning Using Unrelated Donor Transplants in Patients With Acute Myeloid Leukemia

From the Centre for Allogeneic Stem Cell Transplantation, Karolinska University Hospital Huddinge, Stockholm, Sweden; Acute Leukemia Working Party, European Group for Blood and Marrow Transplantation Paris Office, Université Pierre et Marie Curie Paris 6, and Department of Hematology, Hôpital Saint-Antoine; Hôpital Saint-Louis, Paris; Université de Nantes, Nantes, France; University Hospital Dresden, Dresden; University Hospital Leipzig, Leipzig; University of Freiburg, Freiburg; Deutsche Klinik für Diagnostik, Knochenmarktransplantation Zentrum, Wiesbaden; Hannover Medical School, Hannover; and University Hospital Ulm, Ulm, Germany

Corresponding author: Olle Ringdén, MD, PhD, Karolinska University Hospital, Centre for Allogeneic Stem Cell Transplantation, SE-141 86 Stockholm, Sweden; e-mail: olle.ringden{at}labmed.ki.se.

Purpose Reduced intensity conditioning regimen (RIC) is increasingly used in hematopoietic stem cell transplantation (HSCT). Unrelated donor (UD) transplants have more complications. We wanted to examine if RIC is a valid treatment option using UD in acute myeloblastic leukemia (AML).

Patients and Methods Between 1999 and 2005, 401 patients with AML were treated with RIC and 1,154 received myeloablative conditioning (MAC), using UD and reported to the European Group for Blood and Marrow Transplantation Registry. Patients < and 50 years of age were analyzed separately.

Results Patients receiving RIC were older, received transplants more recently, received peripheral blood stem cells more frequently, and were treated with total-body irradiation less often. In multivariable analysis, in patients younger than 50 years of age, nonrelapse mortality (NRM) was similar using RIC (hazard ratio [HR], 0.85; P = .41), relapse was increased (HR, 1.46; P = .02) and leukemia-free survival (LFS) was the same (HR, 0.88; P = .28), as compared with MAC. In patients 50 years of age, NRM was decreased in the RIC group (HR, 0.64; P = .04), relapse probability was not significantly different (HR, 1.34; P = .16) and LFS was similar (HR, 1.04; P = .79) compared with MAC.

Conclusion RIC-UD transplants are associated with higher relapse in AML patients younger than 50 years of age and decreased NRM in those 50 years compared with MAC-UD. LFS was similar after both conditioning regimens, regardless of age. Therefore, RIC-UD extend the use of allotransplants for elderly patients and strategies that decrease relapse should be considered mainly in younger patients with AML.

Supported by European Group for Blood and Marrow Transplantation funds, and grants from the Swedish Cancer Society, the Children's Cancer Foundation, the Swedish Medical Research Council, the Cancer Society in Stockholm, and Karolinska Institutet.

Written on behalf of the the Acute Leukemia Working Party of the European Group for Blood and Marrow Transplantation.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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