Reduced Intensity transplantation vs chemotherapy in CR1. A prospective, pseudorandomized study in 50–70 year old AML patients

The aim of this prospective, international multicenter, pseudorandomized study comparing RICT HCT to standard-of-care chemotherapy in intermediate- or high-risk AML patients 50-70 years using the donor versus no-donor concept. Part 1 included only patients with potential family donors (RD) at the date of HLA-typing of the first potential sibling or CR-date, if later. Part 2 allowed the inclusion of patients without a possible sibling donor using the start of an unrelated donor (URD) search as inclusion date. 360 patients were registered and 309 analyzed. The median follow-up was 47 months (1-168). There was no difference in overall survival (OS) between the RD (n = 124) and the Control (n = 77) groups (p = 0.50, 3-year OS RD: 0.41(95% CI; 0.32-0.50); Controls: 0.49 (95% CI; 0.37-0.59)). The main cause of death was relapse (67% RD; 88% Controls). In Part 2, the 3-year OS was 0.60 (95% CI 0.50-0.70) for URD-HCT (n = 86) and 0.37 (95% CI 0.13-0.62) for Controls (n = 20), respectively (p = 0.10). When analyzing transplanted patients (Part 2), the OS at 3-years was higher for URD-HCT than RD-HCT (0.67 (0.55-0.76) vs. 0.42 (0.26-0.57; p = 0.005). This study doesn't support elderly HLA-identical siblings as donors for older AML patients undergoing a RICT allogeneic HCT in first CR.

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Publication Details

Journal
Bone Marrow Transplantation
Published
2024-09-02
DOI
https://doi.org/10.1038/s41409-024-02408-x
Primary Topic
Acute Myeloid Leukemia Research
Type
article
Field-Weighted Citation Impact
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article

Reduced Intensity transplantation vs chemotherapy in CR1. A prospective, pseudorandomized study in 50–70 year old AML patients

Lars Möllgård, Martin Höglund, Alexandros Spyridonidis, Kari Remes et al.
Bone Marrow Transplantation
Acute Myeloid Leukemia Research
article

Reduced Intensity transplantation vs chemotherapy in CR1. A prospective, pseudorandomized study in 50–70 year old AML patients

Lars Möllgård, Martin Höglund, Alexandros Spyridonidis, Kari Remes, Ain Kaare, Elisabeth Wallhult, Robert Delage, Jürgen Finke, Josée Hébert, Tobias Gedde‐Dahl, Mitchell Sabloff, Ruth Spearing, Malin Nicklasson, David Ritchie, Per Ljungman, Mats Brune, Vladimir Lazarević, Harald Anderson, Thomas Kiss
article en

Abstract

The aim of this prospective, international multicenter, pseudorandomized study comparing RICT HCT to standard-of-care chemotherapy in intermediate- or high-risk AML patients 50-70 years using the donor versus no-donor concept. Part 1 included only patients with potential family donors (RD) at the date of HLA-typing of the first potential sibling or CR-date, if later. Part 2 allowed the inclusion of patients without a possible sibling donor using the start of an unrelated donor (URD) search as inclusion date. 360 patients were registered and 309 analyzed. The median follow-up was 47 months (1-168). There was no difference in overall survival (OS) between the RD (n = 124) and the Control (n = 77) groups (p = 0.50, 3-year OS RD: 0.41(95% CI; 0.32-0.50); Controls: 0.49 (95% CI; 0.37-0.59)). The main cause of death was relapse (67% RD; 88% Controls). In Part 2, the 3-year OS was 0.60 (95% CI 0.50-0.70) for URD-HCT (n = 86) and 0.37 (95% CI 0.13-0.62) for Controls (n = 20), respectively (p = 0.10). When analyzing transplanted patients (Part 2), the OS at 3-years was higher for URD-HCT than RD-HCT (0.67 (0.55-0.76) vs. 0.42 (0.26-0.57; p = 0.005). This study doesn't support elderly HLA-identical siblings as donors for older AML patients undergoing a RICT allogeneic HCT in first CR.

Bone Marrow TransplantationVol. 59(12)
Oslo University Hospital (NO), The Royal Melbourne Hospital (AU), Karolinska University Hospital (SE), Uppsala University Hospital (SE), University of Ottawa (CA), University of Patras (GR), Lund University (SE), Peter MacCallum Cancer Centre (AU), Ottawa Hospital (CA), Sahlgrenska University Hospital (SE), University Medical Center Freiburg (DE), Turku University Hospital (FI), Tartu University Hospital (EE), Christchurch Hospital (NZ), Karolinska Institutet (SE), Hôpital Maisonneuve-Rosemont (CA), Skåne University Hospital (SE), Université Laval (CA), Ottawa Hospital Research Institute (CA), Université de Montréal (CA)
Swedish Cancer Foundation, Cancerfonden, Vetenskapsrådet, NordForsk
Openalex Percentile: Top 78%
Acute Myeloid Leukemia Research
DOIOpen Access PDFOpenAlex
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