Fludarabine or cyclophosphamide in combination with total body irradiation as myeloablative conditioning prior to allogeneic hematopoietic cell transplantation for acute lymphoblastic leukemia: an analysis by the Acute Leukemia Working Party of the EBMT.

Adult Humans Whole-Body Irradiation / adverse effects Retrospective Studies Transplantation, Homologous / adverse effects Cyclophosphamide / therapeutic use Precursor Cell Lymphoblastic Leukemia-Lymphoma / therapy Hematopoietic Stem Cell Transplantation / adverse effects Leukemia, Myeloid, Acute / complications Acute Disease Graft vs Host Disease / etiology Recurrence Transplantation Conditioning / adverse effects

Journal

Bone marrow transplantation

ISSN: 1476-5365

Titre abrégé: Bone Marrow Transplant

Pays: England

ID NLM: 8702459

Informations de publication

Date de publication:
05 2023

Historique:

received: 30 12 2021

accepted: 11 01 2023

revised: 06 01 2023

medline: 8 5 2023

pubmed: 2 2 2023

entrez: 1 2 2023

Statut: ppublish

Résumé

In this registry-based study we retrospectively compared outcomes of allogeneic hematopoietic cell transplantation (allo-HCT) for adult patients with acute lymphoblastic leukemia (ALL) following conditioning with total body irradiation (TBI) combined with either cyclophosphamide (Cy) or fludarabine (Flu). TBI 12 Gy + Cy was used in 2105 cases while TBI 12 Gy + Flu was administered to 150 patients in first or second complete remission. In a multivariate model adjusted for other prognostic factors, TBI/Cy conditioning was associated with a reduced risk of relapse (HR = 0.69, p = 0.049) and increased risk of grade 2-4 acute graft-versus-host disease (GVHD, HR = 1.57, p = 0.03) without significant effect on other transplantation outcomes. In a matched-pair analysis the use of TBI/Cy as compared to TBI/Flu was associated with a significantly reduced rate of relapse (18% vs. 30% at 2 years, p = 0.015) without significant effect on non-relapse mortality, GVHD and survival. We conclude that the use of myeloablative TBI/Cy as conditioning prior to allo-HCT for adult patients with ALL in complete remission is associated with lower risk of relapse rate compared to TBI/Flu and therefore should probably be considered a preferable regimen.

Identifiants

DOI: 10.1038/s41409-023-01917-5 PMID: 36725978

pubmed: 36725978

doi: 10.1038/s41409-023-01917-5

pii: 10.1038/s41409-023-01917-5

doi:

Substances chimiques

fludarabine P2K93U8740

Cyclophosphamide 8N3DW7272P

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

Pagination

506-513

Informations de copyright

Références

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