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Allogeneic Hematopoietic Stem Cell Transplantation in chronic myelogenous leukemia Comparison of ablative and reduced intensity conditioning regimen



Allogeneic Hematopoietic Stem Cell Transplantation in chronic myelogenous leukemia Comparison of ablative and reduced intensity conditioning regimen



Blood 102(11): 471b



Allogeneic Hematopoietic Stem Cell Transplantation (HSCT) in chronic myelogenous leukemia (CML) is one of the standard therapeutic approaches. The feasibility of reduced intensity stem cell transplantation (RIST) has been reported in many high-risk patients with different diagnoses but there is still lack of experience on this application at standard risk population concerning efficacy and toxicity. The aim of this study is to analyze retrospectively our historical data for comparison of ablative HSCT and RIST in standard risk CML patients. We have matched 12 RIST recipients with 12 CML patients, selected among eligible 116 patients, who received ablative regimen in our single center cohort. For matching we selected patients with the same Gratwohl (Lancet 1998; 352:1087) risk score. All the patients received HLA identical sibling peripheral blood stem cells. All the patients, but one were in first chronic phase of CML. Ablative group received Bu-Cy regimen, whereas RIST patients received Fludarabine based regimen (Flu-ATG-Bu (8); Flu-ATG-Cytarabine (2); Flu-Bu (2)). Median age of the RIST patients was 40 (24-47). Ablative patients' median age was 37.5 (29-46). Main transplant characteristics and related complications are given. The median duration of ANC<500 was significantly shorter in RIST recipients. The need for single donor platelets (SDP) was very low in RIST group in comparison to ablative group. RIST recipients experienced less mucositis and diarrhea, which correlated into significantly reduced need for total parenteral nutrition (TPN). We observed almost always a delay in the establishment of donor chimerism in RIST group, which caused relatively frequent use of donor lymphocyte infusion and later on STI571 in patients with mixed chimerism and rising bcr-abl load. We observed remarkably higher de novo onset extensive cGVHD in RIST recipients. Two-year's probability of disease free survival in RIST and ablative group was 72.2% and 75% (log-rank, p=0.67), respectively. In addition, two-year's probability of overall survival in RIST and ablative group was 67.9% and 75% (p=0.78), respectively. As expected RIST recipients showed less regimen related toxicity and myelosupression, but there is no difference in cumulative incidence of early transplant related mortality, acute and chronic GVHD. Upon these encouraging early results we started a single center randomized prospective trial for comparison of RIST and ablative regimen in standard risk CML patients.

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