HLA-matched related peripheral blood stem cell and bone marrow transplantation with RIC regimens yield comparable outcomes for adult AML

EJHaem Pub Date : 2025-01-21 DOI:10.1002/jha2.1088

Takaya Mitsuyoshi, Yasuyuki Arai, Tadakazu Kondo, Takahito Kawata, Shigeki Hirabayashi, Masatsugu Tanaka, Yasuo Mori, Noriko Doki, Tetsuya Nishida, Takeharu Kotani, Masao Ogata, Takayuki Tabayashi, Tetsuya Eto, Masashi Sawa, Kazunori Imada, Junya Kanda, Tatsuo Ichinohe, Yoshiko Atsuta, Masamitsu Yanada

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Abstract

Introduction

Understanding differences in clinical outcomes between PBSCT and BMT is important, and this study compared outcomes of HLA-matched related PBSCT and BMT using reduced-intensity conditioning (RIC) in adult acute myeloid leukemia (AML) patients.

Methods

Data from 402 patients who underwent either PBSCT (n = 294) or BMT (n = 108) between 2000 and 2022 were analyzed using the Japanese nationwide registry database. The primary endpoint was overall survival (OS), and secondary endpoints included disease-free survival (DFS), non-relapse mortality (NRM), and GVHD.

Results

Results indicated no significant difference in 3-year OS (44.6% for PBSCT vs. 46.9% for BMT, HR 1.173, P = 0.299) and DFS (42.1% vs. 41.8%, HR 1.073, P = 0.639). PBSCT was more beneficial for avoiding relapse (20.3% vs. 12.4%, HR, 0.715, P = 0.059). However, PBSCT was associated with higher NRM (20.3% vs. 12.4%, HR 1.801, P = 0.025) due to more frequent, chronic GVHD (HR 1.889, P = 0.035). Subgroup analysis did not reveal specific patient groups that benefited more from PBSCT or BMT. Incidence of extensive chronic GVHD and NRM has improved in PBSCT recipients in recent years (2014–2022).

Conclusions

We conclude that related PBSCT with RIC regimens offers comparable prognosis to BMT for adult AML patients. Further optimization of prophylactic strategies for chronic GVHD is required to improve outcomes after PBSCT.

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hla匹配的相关外周血干细胞和骨髓移植与RIC方案对成人AML产生相当的结果。

简介：了解PBSCT和BMT之间的临床结果差异是很重要的，本研究比较了hla匹配相关PBSCT和BMT在成人急性髓性白血病（AML）患者中使用降低强度调节（RIC）的结果。方法：使用日本全国注册数据库分析2000年至2022年间接受PBSCT （n = 294）或BMT （n = 108）的402例患者的数据。主要终点是总生存期（OS），次要终点包括无病生存期（DFS）、非复发死亡率（NRM）和GVHD。结果：结果显示3年OS （PBSCT 44.6% vs BMT 46.9%, HR 1.173, P = 0.299）和DFS （42.1% vs 41.8%, HR 1.073, P = 0.639）无显著差异。PBSCT更有利于避免复发（20.3% vs. 12.4%， HR, 0.715, P = 0.059）。然而，由于更频繁的慢性GVHD (HR 1.889, P = 0.035)， PBSCT与更高的NRM相关（20.3%比12.4%,HR 1.801, P = 0.025）。亚组分析并没有显示具体的患者组从PBSCT或BMT中获益更多。近年来（2014-2022年），PBSCT接受者中广泛慢性GVHD和NRM的发病率有所改善。结论：我们得出结论，对于成年AML患者，PBSCT联合RIC方案的预后与BMT相当。为了改善PBSCT后的预后，需要进一步优化慢性GVHD的预防策略。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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EJHaem

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