Impact of pretransplant comorbidities on alemtuzumab-based reduced-intensity conditioning allogeneic hematopoietic SCT for patients with high-risk myelodysplastic syndrome and AML

• Published in: Bone marrow transplantation (Basingstoke) Vol. 45; no. 4; pp. 633 - 639
• Main Authors: LIM, Z. Y, INGRAM, W, BRAND, R, HO, A, KENYON, M, DEVEREUX, S, MARSH, J, MUFTI, G. J, PAGLIUCA, A
• Format: Journal Article
• Language: English
• Published: Basingstoke Nature Publishing Group 01.04.2010
• Subjects: Adult; Aged; Alemtuzumab; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Antibodies, Monoclonal - administration & dosage; Antibodies, Monoclonal, Humanized; Antibodies, Neoplasm - administration & dosage; Antineoplastic Agents - administration & dosage; Biological and medical sciences; Bone marrow; Bone marrow, stem cells transplantation. Graft versus host reaction; Care and treatment; Conditioning; Disease-Free Survival; Drug Administration Schedule; Female; Graft Survival; Heart Diseases - complications; Hematologic and hematopoietic diseases; Hematopoietic Stem Cell Transplantation; Hematopoietic stem cells; Humans; Impact prediction; Independent variables; Infection - complications; Leukemia, Myeloid, Acute - complications; Leukemia, Myeloid, Acute - therapy; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Male; Medical sciences; Middle Aged; Monoclonal antibodies; Multivariate analysis; Myelodysplastic syndrome; Myelodysplastic syndromes; Myelodysplastic Syndromes - complications; Myelodysplastic Syndromes - therapy; Patient outcomes; Retrospective Studies; Risk; Risk Assessment; Stem cell transplantation; Survival; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Transplantation; Transplantation Conditioning - methods; Transplantation, Homologous; Transplants & implants; Young Adult; United Kingdom; Netherlands; Antineoplastic agent; Human; AML; High risk; Acute myelogenous leukemia; Hematology; HCT-CI; Malignant hemopathy; Alemtuzumab; Monoclonal antibody; Non myeloablative treatment; reduced-intensity conditioning; Myelodysplastic syndrome; Immunomodulator; Concomitant disease; Allogeneic hematopoietic stem cell transplantation; comorbidity; Immunosuppressive agent; MDS; Cancer
• ISSN: 0268-3369; 1476-5365
• DOI: 10.1038/bmt.2009.236

We report a retrospective analysis of 128 consecutive patients with high-risk myelodysplastic syndrome (MDS) and AML who received an alemtuzumab-based reduced-intensity conditioning hematopoietic SCT (RIC HSCT). The median recipient age was 53 years (range 21-72 years). A total of 49 (38%) recipients had a sibling donor and 79 (62%) had a volunteer-unrelated donor. The hematopoietic cell transplantation-specific comorbidity index (HCT-CI) was assigned to all patients with a score of 0 in 40 (31%), of 1-2 in 45 (35%) and >or=3 in 43 (34%) patients. The 3-year non-relapse mortality (NRM) was 31%, disease-free survival (DFS) was 41% and overall survival (OS) was 46%. The 3-year NRM for patients with a HCT-CI score of 0, 1-2 or >or=3 was 16, 24 and 42%, respectively. The 3-year DFS and OS by HCT-CI was 58 and 69% (score 0), 39 and 39% (score 1-2) and 24 and 32% (score >or=3), respectively. On multivariate analysis, HCT-CI was an independent variable affecting 3-year NRM, DFS and OS (P-value=0.04, 0.01 and <0.01, respectively). Although the disease stage at the time of transplant was an additional independent predictive variable on transplant outcomes, recipient age (>or<50 years) did not have a significant predictive impact. In MDS or AML patients with advanced disease receiving alemtuzumab-based RIC HSCT, the HCT-CI provides an important means of stratifying patients with a high risk of inferior transplant outcomes.