• Saurabh Chhabra, Kwang Woo Ahn, Zhen-Huan Hu, Sandeep Jain, Amer Assal, Jan Cerny, Edward A Copelan, Andrew Daly, Zachariah DeFilipp, Shahinaz M Gadalla, Robert Peter Gale, Siddhartha Ganguly, Betty K Hamilton, Gerhard Carl Hildebrandt, Jack W Hsu, Yoshihiro Inamoto, Abraham S Kanate, H Jean Khoury, Hillard M Lazarus, Mark R Litzow, Sunita Nathan, Richard F Olsson, Attaphol Pawarode, Olle Ringden, Jacob M Rowe, Ayman Saad, Bipin N Savani, Harry C Schouten, Sachiko Seo, Nirav N Shah, Melhem Solh, Robert K Stuart, Celalettin Ustun, Ann E Woolfrey, Jean A Yared, Edwin P Alyea, Matt E Kalaycio, Uday Popat, Ronald M Sobecks, and Wael Saber.
• Division of Hematology/Oncology, Department of Medicine.
• Blood Adv. 2018 Nov 13; 2 (21): 2922-2936.

AbstractAllogeneic hematopoietic cell transplantation (allo-HCT) is a potentially curative treatment of chronic myeloid leukemia (CML). Optimal conditioning intensity for allo-HCT for CML in the era of tyrosine kinase inhibitors (TKIs) is unknown. Using the Center for International Blood and Marrow Transplant Research database, we sought to determine whether reduced-intensity/nonmyeloablative conditioning (RIC) allo-HCT and myeloablative conditioning (MAC) result in similar outcomes in CML patients. We evaluated 1395 CML allo-HCT recipients between the ages of 18 and 60 years. The disease status at transplant was divided into the following categories: chronic phase 1, chronic phase 2 or greater, and accelerated phase. Patients in blast phase at transplant and alternative donor transplants were excluded. The primary outcome was overall survival (OS) after allo-HCT. MAC (n = 1204) and RIC allo-HCT recipients (n = 191) from 2007 to 2014 were included. Patient, disease, and transplantation characteristics were similar, with a few exceptions. Multivariable analysis showed no significant difference in OS between MAC and RIC groups. In addition, leukemia-free survival and nonrelapse mortality did not differ significantly between the 2 groups. Compared with MAC, the RIC group had a higher risk of early relapse after allo-HCT (hazard ratio [HR], 1.85; P = .001). The cumulative incidence of chronic graft-versus-host disease (cGVHD) was lower with RIC than with MAC (HR, 0.77; P = .02). RIC provides similar survival and lower cGVHD compared with MAC and therefore may be a reasonable alternative to MAC for CML patients in the TKI era.

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