The RIC and MAC regimens were dosed at the average daily area under the concentration-vs-time curve (AUC) of 4000 µMol min and 5000–6000 … Full donor chimerism was defined as ≥ 95% donor cells in all lineages tested (lymphoid, myeloid, or whole blood). The most common MAC regimen was Flu/Bu4; the most common RIC regimen was Flu/Bu2. 1154-1161. Patients receiving RIC regimens had a substantially higher relapse rate than those receiving MAC but only a modest decrease in TRM. In a systematic review and meta-analysis, we compared allogeneic transplant outcomes after myeloablative conditioning (MAC) versus reduced-intensity conditioning (RIC) in patients with myelodysplastic syndromes. These data support the use of MAC as the standard of care for fit patients with acute myeloid leukemia or myelodysplastic syndromes. Hematopoietic cell transplantation (HCT) was originally used in acute myeloid leukemia (AML) to treat patients for marrow aplasia resulting from high-dose radiotherapy and chemotherapy, administered with curative intent. Search for other works by this author on: Copyright ©2020 by American Society of Hematology, Clinical Care - Transplantation Regimen Toxicities and Engraftment, https://doi.org/10.1182/blood.V112.11.793.793. Intense immunosuppression (for engraftment and graft-versus-host disease prevention) may constrain the immunologic potency of the graft and limit the antineoplastic capacity of the transplant, thus requiring more intense or more effective conditioning regimens to limit the risks of relapse and permit satisfactory disease-free survival. Subsequent studies demonstrated that donor-derived cells exerted a potent immunologic antileukemic effect, termed graft versus leukemia (GVL), which contributed to cure. The cumulative incidence of chronic GVHD at 18 months post-HCT was 64% (95% CI, 55% to 71.7%) with MAC and 47.6% (95% CI, 38.8 to 58.8) with RIC (P = .019). Multiple covariates were assessed to identify a subset benefiting from MAC or RIC. contributed equally to this work. JCO Clinical Cancer Informatics OS was higher with MAC, but this was not statistically significant. Therefore, RIC allo-SCT for adult ALL (>45 y.) © 2017 King Faisal Specialist Hospital & Research Centre. The cumulative incidence of platelet recovery (> 20,000/µL) at day 60 was 95.5% with MAC and 96.2% with RIC. We report here a systematic review and meta-analysis of randomized controlled trials (RCTs) that directly compared the safety and efficacy of MAC vs RIC regimens in MDS. 11 2017 & EBMT RICMAC Trial Kroger, N. et al. H.J.D. However, the discrepancy in relapse rate exceeded what was anticipated, and the trial was halted because of ethical concerns rather than statistical considerations. Asterisk with author names denotes non-ASH members. An 18-month pointwise comparison showed a difference in RFS of 20.4% (95% CI, 8.9 to 32) in favor of MAC. U10HL069294 to the Blood and Marrow Transplant Clinical Trials Network) and National Cancer Institute and by National Institutes of Health Grant No. Blood 2018; 132 (Supplement 1): 5770. doi: https://doi.org/10.1182/blood-2018-99-114452. The most common adverse events were mucositis and abnormal liver function with MAC versus abnormal liver function and dyspnea with RIC (Appendix Fig A2, online only). In this multicenter retrospective study, the outcomes of 601 adult (age at transplantation >45 y.) But Kroger et al reported significantly lower overall infections rate at day 100 (4.3 vs. 6.9, p=0.002) and at total follow up (1.4 vs. 2.0, p= 0.002) for RIC. For more information about ASCO’s conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/site/ifc. Only 2 published randomized clinical trials were found, with a pooled sample size of 183 (RIC, 92; MAC, 91). Enter words / phrases / DOI / ISBN / authors / keywords / etc. Each center selected one preferred MAC and RIC regimen. published online before print Infection Summary by Treatment Arm. Infectious complications were comparable in both treatment arms (Appendix Table A2, online only). OS at 18 months was 77.5% (95% CI, 69.4% to 83.7%) with MAC and 67.7% (95% CI, 59.1% to 74.9%) with RIC (Fig 2A). Processed as a Rapid Communication manuscript. The difference in OS favoring Flu/Bu4 over Flu/Bu2 (10.8%; 95% CI, −2.7% to 24.3%) was not statistically significant. Disclosures: No relevant conflicts of interest to declare. With a median follow-up of 13 months (range, 1–127), the incidences of grade II-IV and grade III-IV acute GVHD were: 35%, 14%, and 28%, 10% in the MAC and RIC groups respectively (P=NS).
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