Reduced-intensity Conditioning for Stem Cell Transplantation Effective in MDS

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The results of this study suggest that RIC may be an alternative to MAC, particularly for patients of low cytogenetic risk.
The results of this study suggest that RIC may be an alternative to MAC, particularly for patients of low cytogenetic risk.

Reduced-intensity conditioning (RIC) resulted in similar outcomes to standard-dose myeloablative conditioning (MAC) among patients with myelodysplastic syndrome (MDS) undergoing allogeneic stem-cell transplantation (alloSCT), according to a study published in the Journal of Clinical Oncology.1

Retrospective studies suggested that RIC results in a reduced risk of non-relapse mortality, but increases the risk of relapse, compared with MAC. The aim of this study was to eliminate selection bias by comparing RIC and MAC in a prospective setting.

This multicenter, open-label, phase 3 trial randomly assigned 129 patients with MDS or secondary acute myeloid leukemia to receive MAC or RIC followed by alloSCT.

At baseline, the median age was 50.5 and 36.5% of patients had received prior induction chemotherapy. Most characteristics were similar between arms, except 30% of patients in the RIC arm had greater than 5% blasts vs 18% in the MAC arm.

Engraftment was similar between arms, and the cumulative incidence of grade 2 to 4 acute graft-versus-host disease was 32.3% and 37.5% in the RIC and MAC arms, respectively, which increased to 61.6% and 64.7%, respectively, at 24 months.

Patients who received MAC demonstrated a higher cumulative incidence of 1-year non-relapse mortality, with a rate of 25% (95% CI, 15%-36%) compared with 15% (95% CI, 6%-24%) in the RIC arm.

The 2-year relapse-free survival was similar with RIC (62%; 95% CI, 50%-74%) compared with MAC (58%; 95% CI, 46%-71%; P = .58).

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Overall survival was also similar, with 2-year rates of 76% (95% CI, 66%-87%) compared with 63% (95% CI, 51%-75%) in the RIC and MAC arms, respectively (P = .08).

The results of this study suggest, according to the authors, that RIC may be an alternative to MAC, particularly for patients of low cytogenetic risk.

Reference

  1. Kröger N, Iacobelli S, Franke GN, et al. Dose-reduced versus standard conditioning followed by allogeneic stem-cell transplantation for patients with myelodysplastic syndrome: a prospective randomized phase III study fo the EBMT (RICMAC Trial). J Clin Oncol. 2017 May 2. doi:10.1200/JCO.2016.70.7349 [Epub ahead of print]

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