Comorbidities in transplant recipients with acute myeloid leukemia receiving low-intensity conditioning regimens: an ALWP EBMT study

Joshua A. Fein, Roni Shouval, Jacques Emmanuel Galimard, Myriam Labopin, Gérard Socié, Jürgen Finke, Jan J. Cornelissen, Ram Malladi, Maija Itälä-Remes, Patrice Chevallier, Kim H. Orchard, Donald Bunjes, Mahmoud Aljurf, Marie Thérèse Rubio, Jurjen Versluis, Mohamad Mohty, Arnon Nagler

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Older age and a high burden of comorbidities often drive the selection of low-intensity conditioning regimens in allogeneic hematopoietic stem cell transplantation recipients. However, the impact of comorbidities in the low-intensity conditioning setting is unclear. We sought to determine the contribution of individual comorbidities and their cumulative burden on the risk of nonrelapse mortality (NRM) among patients receiving low-intensity regimens. In a retrospective analysis of adults (≥18 years) who underwent transplantation for acute myeloid leukemia in the first complete remission between 2008 and 2018, we studied recipients of low-intensity regimens as defined by the transplantation conditioning intensity (TCI) scale. Multivariable Cox models were constructed to study associations of comorbidities with NRM. Comorbidities identified as putative risk factors in the low-TCI setting were included in combined multivariable regression models assessed for overall survival, NRM, and relapse. A total of 1663 patients with a median age of 61 years received low-TCI regimens. Cardiac comorbidity (including arrhythmia/valvular disease) and psychiatric disease were associated with increased NRM risk (hazard ratio [HR], 1.54; 95% confidence interval [CI], 1.13-2.09 and HR, 1.69; 95% CI, 1.02-2.82, respectively). Moderate pulmonary dysfunction, though prevalent, was not associated with increased NRM. In a combined model, cardiac, psychiatric, renal, and inflammatory bowel diseases were independently associated with adverse transplantation outcomes. These findings may inform patient and regimen selection and reinforce the need for further investigation of cardioprotective transplantation approaches.

Original languageEnglish
Pages (from-to)2143-2152
Number of pages10
JournalBlood advances
Issue number10
StatePublished - 23 May 2023
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2023 by The American Society of Hematology.


The authors thank the data managers for their excellent work and the patients who provided data. They also thank all of the European Society for Blood and Marrow Transplantation centers and national registries for contributing patients to this study (supplemental Appendix). This work is supported by funding and a grant from the American Society for Hematology HONORS award (J.A.F.) and the Memorial Sloan Kettering Cancer Center Core grant, National Cancer Institute, National Institutes of Health (grant P30 CA008748) (R.S.).

FundersFunder number
American Society for Hematology
National Institutes of HealthP30 CA008748
National Cancer Institute


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