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The impact of graft-versus-host disease prophylaxis in reduced-intensity conditioning allogeneic stem cell transplant in acute myeloid leukemia: a study from the Acute Leukemia Working Party of the European Group for Blood and Marrow Transplantation

The impact of graft-versus-host disease prophylaxis in reduced-intensity conditioning allogeneic stem cell transplant in acute myeloid leukemia: a study from the Acute Leukemia Working Party of the European Group for Blood and Marrow Transplantation

Fecha de publicación: 01/05/2015

Autores de IIS La Fe

Miguel Ángel Sanz Alonso

Autor

Participantes ajenos a IIS La Fe

Rubio MT
Labopin M
Blaise D
Socié G
Contreras RR
Chevallier P
Vigouroux S
Huynh A
Shimoni A
Bulabois CE
Caminos N
López-Corral L
Nagler A
Mohty M

Grupos

Hematología y Hemoterapia

Investigador Principal

Javier De La Rubia Comos

Abstract

The impact of the intensity of graft-versus-host-disease immunoprophylaxis on transplantation outcomes in patients undergoing transplantation following reduced-intensity conditioning is unclear. This study addresses this issue in 228 adult patients above 50 years of age with acute myeloid leukemia in first complete remission given peripheral blood stem cells from HLA-identical siblings after fludarabine and 2 days of intravenous busulfan reduced-intensity conditioning. A total of 152 patients received anti-thymocyte globulin, either in combination with cyclosporine A in 86 patients (group 1), or with cyclosporine A and mycophenolate mofetil or short course methotrexate in 66 patients (group 2). The remaining 76 patients did not receive anti-thymocyte globulin but were given cyclosporine A and methotrexate or mycophenolate mofetil (group 3). Incidences of grade II-IV acute graft-versus-host-disease were comparable in the three groups (16.5%, 29.5% and 19.5% in groups 1, 2 and 3, respectively, P= 0.15). In multivariate analysis, the absence of anti-thymocyte globulin was the only factor associated with a higher risk of chronic graft-versus-host-disease (P= 0.005), while the use of triple immunosuppression (group 3) was associated with an increased risk of relapse (P= 0.003). In comparison to anti-thymocyte globulin and cyclosporine A alone, the other two strategies of graft-versus-host-disease prophylaxis were associated with reduced leukemia-free survival and overall survival (P= 0.001 for each parameter), independently of the dose of anti-thymocyte globulin. These data suggest that fine tuning of the intensity of this prophylaxis can affect the out-come of transplantation and that anti-thymocyte globulin and cyclosporine A alone should be the preferred combination with the fludarabine-busulfan reduced-intensity conditioning regimen and sibling donors.

Datos de la publicación

ISSN/ISSNe:: 0390-6078, 1592-8721
Tipo:: Article
Páginas:: 683-689
DOI:: 10.3324/haematol.2014.119339
Factor de Impacto:: 2,959 SCImago ℠
Cuartil:: Q1 SCImago ℠

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Filiaciones

Labopin M:: Hôpital Saint Antoine, Service d'Hématologie et de Thérapie Cellulaire, Paris, France EBMT Data Office, Hôpital Saint Antoine, Paris, France
Blaise D:: Programme de Transplantation & Therapie Cellulaire Centre de Recherche en Cancérologie de Marseille, Institut Paoli Calmettes, Marseille, France
Socié G:: Hôpital St. Louis, Dept. of Hematology - BMT, Paris, France
Contreras RR:: IMIBIC/Reina Sofia Hospital, Cordoba, Spain
Chevallier P:: CHU Nantes, Dept. D'Hématologie, France
Sanz MA:: Hospital Universidad La Fe, Servicio de Hematologia y Oncologia, Valencia, Spain
Vigouroux S:: CHU Bordeaux, Hôpital Haut-leveque, Pessac, France
Huynh A:: Hôpital Purpan, CHU de Toulouse, Dept. Hematologie, France
Shimoni A:: Department of Bone Marrow Transplantation, Sheba Medical Center, Tel-Hashomer, Tel-Aviv University, Israel
Bulabois CE:: Hôpital A. Michallon, Hématologie Clinique, Pole Cancérologie, Grenoble, France
Caminos N:: Donostia Hospital, San Sebastian, Spain
López-Corral L:: Hospital Clinico, Servicio de Hematologia, Instituto Biosanitario de Salamanca (IBSAL), Spain
Nagler A:: Department of Bone Marrow Transplantation, Sheba Medical Center, Tel-Hashomer, Tel-Aviv University, Israel EBMT Data Office, Hôpital Saint Antoine, Paris, France
Mohty M:: Hôpital Saint Antoine, Service d'Hématologie et de Thérapie Cellulaire, Paris, France Université Pierre et Marie Curie, Paris, France INSERM UMRs938, CDR Saint Antoine, Paris, France EBMT Data Office, Hôpital Saint Antoine, Paris, France

Campos de estudio

Proyectos asociados

RED DE INVESTIGACION COOPERATIVA DE CANCER

RD06/0020/0031 . INSTITUTO DE SALUD CARLOS III; FUNDACIÓN PARA LA INVESTIGACIÓN DEL HOSPITAL UNIVERSITARIO LA FE DE LA COMUNIDAD VALENCIANA . 2006

PROYECTO CAIBER

CAI08/01/0061 . INSTITUTO DE SALUD CARLOS III; FUNDACIÓN PARA LA INVESTIGACIÓN DEL HOSPITAL UNIVERSITARIO LA FE DE LA COMUNIDAD VALENCIANA . 2009

CREACION Y MEJORA DE INFRAESTRUCTURAS EN MEDICINA REGENERATIVA

Investigador Principal: FUNDACIÓN PARA LA INVESTIGACIÓN DEL HOSPITAL UNIVERSITARIO LA FE DE LA COMUNIDAD VALENCIANA

PLE2009-0141 ACI-PLAN E . MINISTERIO DE CIENCIA E INNOVACION; FUNDACIÓN PARA LA INVESTIGACIÓN DEL HOSPITAL UNIVERSITARIO LA FE DE LA COMUNIDAD VALENCIANA . 2009