Sibai Hassan, Falcone Umberto, Deotare Uday, Michelis Fotios V, Uhm Jieun, Gupta Vikas, Kuruvilla John, Lipton Jeffrey H, Seftel Matthew D, Messner Hans A, Kim Dennis Dong Hwan
Allogeneic Blood and Marrow Transplant Program, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada.
Allogeneic Blood and Marrow Transplant Program, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada.
Biol Blood Marrow Transplant. 2016 Dec;22(12):2270-2275. doi: 10.1016/j.bbmt.2016.08.030. Epub 2016 Sep 3.
Reduced-intensity conditioning (RIC) has been shown to have similar overall survival (OS) but higher relapse rates compared with myeloablative (MAC) regimens in patients with myeloid malignancies undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT). Using propensity score matching (PSM) analysis, well-balanced pairs of different variables can be compared effectively. We retrospectively compared allo-HSCT recipients with acute myeloid leukemia or myelodysplasia receiving a RIC regimen (FBT200; fludarabine 30 mg/m/day for 4 days, busulfan 3.2 mg/kg/day for 2 days, and total body irradiation [TBI] 200 cGy) or MAC regimen (FBT400; fludarabine 50 mg/m/day for 4 days, busulfan 3.2 mg/kg/day for 4 days, and TBI 400 cGy). A total of 248 patients (121 in the RIC group and 127 in the MAC group) were included in the analysis. No statistically significant difference was observed in 2-year OS (RIC group, 45.2 ± 5.0%; MAC group, 51.7 ± 5.2%; P = .541), nonrelapse mortality (NRM; RIC group, 28.7 ± 2.8% MAC group, 34.7 ± 4.6%; P = .368), and acute graft-versus-host disease (GVHD) (P = .171) or chronic GVHD (P = .605) at 1 year. The cumulative incidence of relapse (CIR) at 2 years was statistically significantly different between the 2 groups, however (RIC, 26.1 ± 2.6%; MAC, 14.2 ± 3.5%; P = .033). When PSM was applied to the study population, 42 case-control pairs were evenly matched. PSM analysis confirmed no statistically significant difference in 2-year OS (RIC, 49.0 ± 9.1%; MAC, 54.9 ± 7.7%; P = .718), NRM (RIC, 22.2 ± 2.3%; MAC, 33.3 ± 2.8%; P = .238), or CIR (RIC, 25.7 ± 2.6%; MAC, 9.5 ± 1.1%; P = .315) in the PSM pairs. Our findings demonstrate that after applying PSM, FBT 200 RIC conditioning has comparable OS, NRM, and CIR to FBT 400 MAC conditioning before allo-HSCT.
对于接受异基因造血干细胞移植（allo-HSCT）的髓系恶性肿瘤患者，与清髓性（MAC）方案相比，减低强度预处理（RIC）已显示出总体生存率（OS）相似，但复发率更高。使用倾向评分匹配（PSM）分析，可以有效比较不同变量的平衡配对。我们回顾性比较了接受RIC方案（FBT200；氟达拉滨30mg/m²/天，共4天，白消安3.2mg/kg/天，共2天，全身照射[TBI]200cGy）或MAC方案（FBT400；氟达拉滨50mg/m²/天，共4天，白消安3.2mg/kg/天，共4天，TBI 400cGy）的急性髓系白血病或骨髓增生异常综合征的allo-HSCT受者。共有248例患者（RIC组121例，MAC组127例）纳入分析。2年OS（RIC组，45.2±5.0%；MAC组，51.7±5.2%；P = 0.541）、非复发死亡率（NRM；RIC组，28.7±2.8%，MAC组，34.7±4.6%；P = 0.368）、1年时的急性移植物抗宿主病（GVHD）（P = 0.171）或慢性GVHD（P = 0.605）均未观察到统计学显著差异。然而，两组2年时的累积复发率（CIR）有统计学显著差异（RIC，26.1±2.6%；MAC，14.2±3.5%；P = 0.033）。当对研究人群应用PSM时，42对病例对照匹配良好。PSM分析证实，PSM配对中的2年OS（RIC，49.0±9.1%；MAC，54.9±7.7%；P = 0.718）、NRM（RIC，22.2±2.3%；MAC，33.3±2.8%；P = 0.238）或CIR（RIC，25.7±2.6%；MAC，9.5±1.1%；P = 0.315）无统计学显著差异。我们的研究结果表明，应用PSM后，FBT 200 RIC预处理在allo-HSCT前的OS、NRM和CIR与FBT 400 MAC预处理相当。
