Intravenous Busulfan Compared with Total Body Irradiation Pretransplant Conditioning for Adults with Acute Lymphoblastic Leukemia.

Kebriaei, Partow; Anasetti, Claudio; Zhang, Mei-Jie; Wang, Hai-Lin; Aldoss, Ibrahim; de Lima, Marcos; Khoury, H Jean; Sandmaier, Brenda M; Horowitz, Mary M; Artz, Andrew; Bejanyan, Nelli; Ciurea, Stefan; Lazarus, Hillard M; Gale, Robert Peter; Litzow, Mark; Bredeson, Christopher; Seftel, Matthew D; Pulsipher, Michael A; Boelens, Jaap-Jan; Alvarnas, Joseph; ... (2018). Intravenous Busulfan Compared with Total Body Irradiation Pretransplant Conditioning for Adults with Acute Lymphoblastic Leukemia. Biology of blood and marrow transplantation, 24(4), pp. 726-733. Elsevier 10.1016/j.bbmt.2017.11.025

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Total body irradiation (TBI) has been included in standard conditioning for acute lymphoblastic leukemia (ALL) before hematopoietic cell transplantation (HCT). Non-TBI regimens have incorporated busulfan (Bu) to decrease toxicity. This retrospective study analyzed TBI and Bu on outcomes of ALL patients 18-60 years old, in first or second complete remission (CR), undergoing HLA-compatible sibling, related, or unrelated donor HCT, who reported to the Center for International Blood and Marrow Transplant Research from 2005 to 2014. TBI plus etoposide (25%) or cyclophosphamide (75%) was used in 819 patients, and intravenous Bu plus fludarabine (41%), clofarabine (30%), cyclophosphamide (15%), or melphalan (13%) was used in 299 patients. Bu-containing regimens were analyzed together, since no significant differences for patient outcomes were noted between them. Bu patients were older, with better performance status; took longer to achieve first CR and receive HCT; were treated more recently; and were more likely to receive peripheral blood grafts, antithymocyte globulin, or tyrosine kinase inhibitors. With median follow-up of 3.6 years for Bu and 5.3 years for TBI, adjusted 3-year outcomes showed treatment-related mortality Bu 19% versus TBI 25% (P = .04); relapse Bu 37% versus TBI 28% (P = .007); disease-free survival (DFS) Bu 45% versus TBI 48% (P = .35); and overall survival (OS) Bu 57% versus TBI 53% (P = .35). In multivariate analysis, Bu patients had higher risk of relapse (relative risk, 1.46; 95% confidence interval, 1.15 to 1.85; P = .002) compared with TBI patients. Despite the higher relapse, Bu-containing conditioning led to similar OS and DFS following HCT for ALL.

Item Type:

 Journal Article (Original Article)

Division/Institute:

 04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Clinic of Haematology and Central Haematological Laboratory
04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > DBMR Forschung Mu35 > Forschungsgruppe Hämatologie / Onkologie (Pädiatrie)
04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > DBMR Forschung Mu35 > Forschungsgruppe Hämatologie / Onkologie (Pädiatrie)

ISSN:

 1083-8791

Publisher:

 Elsevier

Language:

 English

Submitter:

 Pierrette Durand Lüthi

Date Deposited:

 12 Nov 2019 08:57

Last Modified:

 12 Nov 2019 08:57

Publisher DOI:

 10.1016/j.bbmt.2017.11.025

PubMed ID:

 29197676

Additional Information:

Tätigkeit in der Forschungsgruppe: Bacher U. Center of Laboratory Medicine (ZLM)/University Institute of Clinical Chemistry, Inselspital, Bern University Hospital, Bern, Switzerland

Uncontrolled Keywords:

 Acute lymphoblastic leukemia Allogeneic transplant Busulfan Total body irradiation

BORIS DOI:

 10.7892/boris.124534

URI:

 https://boris.unibe.ch/id/eprint/124534

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