Impact of pretransplant comorbidities on alemtuzumab-based reduced-intensity conditioning allogeneic hematopoietic SCT for patients with high-risk myelodysplastic syndrome and AML

Abstract

We report a retrospective analysis of 128 consecutive patients with high-risk myelodysplastic syndrome (MDS) and AML who received an alemtuzumab-based reducedintensity conditioning hematopoietic SCT (RIC HSCT). The median recipient age was 53 years (range 21-72 years). A total of 49 (38%) recipients had a sibling donor and 79 (62%) had a volunteer-unrelated donor. The hematopoietic cell transplantation-specific comorbidity index (HCT-CI) was assigned to all patients with a score of 0 in 40 (31%), of 1-2 in 45 (35%) and X3 in 43 (34%) patients. The 3-year non-relapse mortality (NRM) was 31%, disease-free survival (DFS) was 41% and overall survival (OS) was 46%. The 3-year NRM for patients with a HCT-CI score of 0, 1-2 or X3 was 16, 24 and 42%, respectively. The 3-year DFS and OS by HCT-CI was 58 and 69% (score 0), 39 and 39% (score 1-2) and 24 and 32% (score X3), respectively. On multivariate analysis, HCT-CI was an independent variable affecting 3-year NRM, DFS and OS (P-value ¼ 0.04, 0.01 and o0.01, respectively). Although the disease stage at the time of transplant was an additional independent predictive variable on transplant outcomes, recipient age (4/o50 years) did not have a significant predictive impact. In MDS or AML patients with advanced disease receiving alemtuzumab-based RIC HSCT, the HCT-CI provides an important means of stratifying patients with a high risk of inferior transplant outcomes.

Comparison of conditioning regimens of various intensities for allogeneic hematopoietic SCT using HLA-identical sibling donors in AML and MDS with <10% BM blasts: a report from EBMT

“…The 3-year outcomes of the IntermRIC regimens in the current study are in line with those found in prior studies (after excluding patients in an advanced disease status). 4,16,19,[32][33][34][35] In addition, long-term follow-up of the most common NMA protocol (Fludarabine þ 200 cGy TBI 36 ) in patients with AML in first or second CR reported a 6-year relapse incidence of 62%, a 27% PFS and an OS of 29%, similar to our cohort of NMA recipients. 37 Long-term comparative outcomes of various conditioning regimen intensities for AlloHSCT in AML and poor-risk MDS are not available to date.…”

Influence of age on outcome after allogeneic hematopoietic cell transplantation: a single center study in patients aged ⩾60

“…As comorbidities may have a significant negative influence on outcome after allogeneic HCT 23,24 evaluation of the HCT-CI 11 should be applied for comparison of results of the respective patient cohorts in different studies. In our study the HCT-CI was a median of 2.5, which is slightly higher than in other published studies and has to be kept in mind when comparing the OS rates.…”

Concise Review: The Role of Hematopoietic Stem Cell Transplantation in the Treatment of Acute Myeloid Leukemia

“…While older age has been widely used to exclude patients from transplantation, assessment of comorbid conditions as measured by the hematopoietic cell transplantationspecific comorbidity index may help estimate risk of treatment-related mortality following HSCT [15][16][17]. In the presence of significant comorbidities, the danger of transplantation is far greater than postremission chemotherapy and may exclude patients from HSCT.…”