Spyridonidis Alexandros, Labopin Myriam, Savani Bipin N, Niittyvuopio Riitta, Blaise Didier, Craddock Charles, Socié Gerard, Platzbecker Uwe, Beelen Dietrich, Milpied Noel, Cornelissen Jan J, Ganser Arnold, Huynh Anne, Griskevicius Laimonas, Giebel Sebastian, Aljurf Mahmoud, Brissot Eolia, Malard Florent, Esteve Jordi, Peric Zinaida, Baron Frédéric, Ruggeri Annalisa, Schmid Christoph, Gilleece Maria, Gorin Norbert-Claude, Lanza Francesco, Shouval Roni, Versluis Jurjen, Bug Gesine, Fløisand Yngvar, Ciceri Fabio, Sanz Jamie, Bazarbachi Ali, Nagler Arnon, Mohty Mohamad
Department of Internal Medicine, Bone Marrow Transplantation Unit, University Hospital of Patras, Patras, Greece.
Service d' Hématologie Clinique et Thérapie Cellulaire, Hospital Saint-Antoine, Sorbonne Université, Centre de Recherche Saint-Antoine (CRSA), Paris, France.
Bone Marrow Transplant. 2020 Jun;55(6):1114-1125. doi: 10.1038/s41409-020-0803-y. Epub 2020 Jan 29.
To address limitations of the currently used reduced-intensity/myeloablative conditioning (RIC/MAC) classification scheme we aimed to develop a tool that can capture more standardized the conditioning intensity of allogeneic hematopoietic cell transplantation (HCT). We assigned intensity weight scores for frequently used conditioning regimen components and used their sum to generate the transplant conditioning intensity (TCI) score. We retrospectively tested the impact of TCI on 8255 adult (45-65 years) acute myeloid leukemia patients who underwent HCT in first complete remission. A Cox model for early nonrelapse mortality (NRM) yielded a 3-group TCI risk scheme (low, intermediate, high) with respective TCI scores of [1-2], [2.5-3.5] and [4-6]. On multivariate modeling, TCI grouping was highly and better predictive for early (day 100 and 180) NRM, 2-year NRM and relapse (REL) as compared with the RIC/MAC classification. Validation was done on 200 bootstrap samples. Moreover, TCI scoring enabled the identification of a distinct subgroup of RIC and MAC conditioning regimens with an intermediate TCI [2.5-3.5] score that had identical outcomes and which are frequently referred as "reduced toxicity conditioning". TCI scheme provides an improvement of the RIC/MAC classification. We propose TCI as a new tool to define and measure the conditioning regimen intensity.
为解决当前使用的减低强度/清髓性预处理（RIC/MAC）分类方案的局限性，我们旨在开发一种能够更标准化地反映异基因造血细胞移植（HCT）预处理强度的工具。我们为常用的预处理方案组成部分分配强度权重分数，并将它们的总和用于生成移植预处理强度（TCI）分数。我们回顾性地测试了TCI对8255例年龄在45至65岁之间、处于首次完全缓解期且接受HCT的成年急性髓系白血病患者的影响。一个针对早期非复发死亡率（NRM）的Cox模型得出了一个3组TCI风险方案（低、中、高），其各自的TCI分数为[1 - 2]、[2.5 - 3.5]和[4 - 6]。在多变量建模中，与RIC/MAC分类相比，TCI分组对早期（第100天和180天）NRM、2年NRM和复发（REL）具有更高且更好的预测性。在200个自助抽样样本上进行了验证。此外，TCI评分能够识别出一组具有中等TCI[2.5 - 3.5]分数的RIC和MAC预处理方案的不同亚组，这些方案具有相同的结果，并且常被称为“减低毒性预处理”。TCI方案改进了RIC/MAC分类。我们提议将TCI作为一种定义和测量预处理方案强度的新工具。
