Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions
Pre-Transplant Conditioning Methods Evaluated
J Clin Oncol; ePub 2017 Feb 13; Scott, et al
Reduced-intensity conditioning (RIC) led to lower treatment-related mortality but higher relapse rates compared with myeloablative conditioning (MAC) before allogeneic hematopoietic cell transplantation in a phase 3 randomized study involving 272 individuals.
Participants had either acute myeloid leukemia or myelodysplastic syndromes, HCT comorbidity index ≤4, and <5% marrow myeloblasts pre-HCT. They were randomly assigned to receive MAC (n=135) or RIC (n=137), followed by HCT from HLA-matched related or unrelated donors. Investigators looked at overall survival, relapse-free survival, and treatment-related mortality. Among the results:
- Treatment-related mortality with RIC was 4%, vs 15% in the MAC group.
- Relapse-free survival in the RIC group was 47%, vs 68% among MAC patients.
- Relapse rates with RIC was 48%, vs 14% with MAC.
- Overall survival was better with MAC, but the difference was not statistically significant.
The authors concluded that their findings support MAC as the standard of care in such patients.
Scott B, Pasquini M, Logan B, et al. Myeloablative versus reduced-intensity hematopoietic cell transplantation for acute myeloid leukemia and myelodysplastic syndromes. [Published online ahead of print February 13, 2017]. J Clin Oncol. doi:10.1200/JCO.2016.70.7091.