Optimizing Patient Selection for Reduced Nonrelapse Mortality After Reduced-Intensity Conditioning: A CIBMTR Analysis

Area of Science:

• Hematopoietic cell transplantation (HCT)
• Oncology
• Immunology

Background:

• Reduced-intensity conditioning (RIC) offers lower nonrelapse mortality (NRM) but higher relapse risk than myeloablative conditioning (MAC) in allogeneic HCT.
• The Risk assessment for the Intensity of Conditioning regimen in Elderly patients (RICE) score was developed to identify patients benefiting from RIC.
• The RICE score uses advanced age, high comorbidities, and umbilical cord blood donor status.

Purpose of the Study:

• To evaluate the RICE score's applicability in a Western population.
• To validate the RICE score using a CIBMTR dataset.

Main Methods:

• Analysis of 2595 patients aged 40-65 undergoing first HCT for AML and MDS (2009-2015).
• Primary endpoint: NRM, stratified by conditioning intensity and RICE score.

Main Results:

• In low-RICE score patients, MAC showed similar NRM but lower relapse, improving disease-free survival (DFS).
• In high-RICE score patients, RIC significantly lowered NRM versus MAC, though DFS was similar due to higher RIC relapse rates.

Conclusions:

• The RICE score is externally validated in a Western cohort.
• The RICE score can guide conditioning intensity selection based on individual risk factors.
• This tool may improve HCT outcomes by refining NRM risk assessment.