Reduced-intensity benefits confirmed for AML cell transplantation

NewsGuard 100/100 Score

By Lynda Williams, Senior medwireNews Reporter

Reduced-intensity conditioning reduces toxicity associated with allogeneic hematopoietic cell transplantation (HCT) for acute myeloid leukemia (AML) without affecting long-term outcomes, show results from the first randomized trial of this treatment.

The findings published in The Lancet Oncology confirm the reported benefits of a fludarabine-based reduced-intensity conditioning over standard treatment, potentially allowing curative treatment of older AML patients and those with comorbidity unsuitable for conventional conditioning.

Despite being halted early due to slow patient accrual, the trial demonstrated that the 99 patients given reduced-intensity and the 96 patients given standard conditioning did not significantly differ with regards to relapse at 3 years (28 vs 26%), disease-free survival at 3 years(58 vs 56%), or overall survival (61 vs 58%).

All patients assigned to receive the reduced-intensity regimen were discharged from hospital, whereas there were eight early in-hospital deaths in the standard regimen arm, a significant difference.

Furthermore, per-protocol analysis showed that the reduced-intensity regimen was associated with a small but significant decrease in nonrelapse mortality at 1 year compared with standard treatment (8 vs 17%; hazard ratio=0.42). This benefit was found to have occurred in patients aged 41 to 60 years only.

Patients in the reduced-intensity group were significantly less likely to develop grade 3 to 4 oral mucositis (50 vs 73 patients), although no significant difference was found for other toxicity markers.

"Patients aged 18-60 years with AML in first complete remission who are candidates for allogeneic [HCT] should be advised on the equivalent efficacy of reduced-intensity conditioning versus standard conditioning in terms of overall outcome and early toxic effects and mortality," recommend Martin Bornhauser (Medizinische Klinik und PoliklinikI, Dresden, Germany) and co-authors.

"Physicians and patients should know that reduced intensity conditioning is an alternative for patients with AML in first complete remission, especially when the tolerability of intensive conditioning is in question."

The open-label trial was conducted in patients aged 18 to 60 years with cytogenetically defined intermediate- or high-risk AMLwho were in first remission.

The reduced-intensity regimen consisted of total body irradiation in four 2 Gy doses plus fludarabine 150 mg/m2 versus six 2 Gy doses of radiation with cyclophosphamide 120 mg/kg. Both patient groups also received ciclosporin and methotrexate.

Licensed from medwireNews with permission from Springer Healthcare Ltd. ©Springer Healthcare Ltd. All rights reserved. Neither of these parties endorse or recommend any commercial products, services, or equipment.


The opinions expressed here are the views of the writer and do not necessarily reflect the views and opinions of News Medical.
Post a new comment

While we only use edited and approved content for Azthena answers, it may on occasions provide incorrect responses. Please confirm any data provided with the related suppliers or authors. We do not provide medical advice, if you search for medical information you must always consult a medical professional before acting on any information provided.

Your questions, but not your email details will be shared with OpenAI and retained for 30 days in accordance with their privacy principles.

Please do not ask questions that use sensitive or confidential information.

Read the full Terms & Conditions.

You might also like...
World's first human mini-brain with a fully functional blood-brain barrier developed