Transplantation conditioning regimens and outcomes after allogeneic hematopoietic cell transplantation in children and adolescents with acute lymphoblastic leukemia. Biol Blood Marrow Transplant 2013 Feb;19(2):255-9
Date
10/09/2012Pubmed ID
23041605Pubmed Central ID
PMC3553255DOI
10.1016/j.bbmt.2012.09.019Scopus ID
2-s2.0-84872606979 (requires institutional sign-in at Scopus site) 27 CitationsAbstract
Relapse is common after hematopoietic stem cell transplantation (HSCT) for acute lymphoblastic leukemia (ALL). Although 1200 cGy total body irradiation (TBI) and cyclophosphamide (Cy) is the standard conditioning regimen, attempts to reduce relapse have led to the addition of a second chemotherapeutic agent and/or higher dose of TBI. We examined HSCT outcomes in patients age <18 years with ALL, in second or subsequent remission or in relapse at transplantation. Most transplantations were performed with the patient in remission. Patients received grafts from an HLA-matched sibling or unrelated donor. Four treatment groups were created: (1) Cy + TBI ≤ 1200 cGy (n = 304), (2) Cy + etoposide + TBI ≤ 1200 cGy (n = 108), (3) Cy + TBI ≥ 1300 cGy (n = 327), and (4) Cy + etoposide + TBI ≥ 1300 cGy (n = 26). Neither TBI > 1200 cGy nor the addition of etoposide resulted in fewer relapses. The 5-year probability of relapse was 30% for group 1, 28% for group 2, 35% for group 3, and 31% for group 4. However, transplantation-related mortality was higher (35% versus 25%, P = .02) and overall survival lower (36% versus 48%, P = .03) in group 4 compared with group 3. Our findings indicate that compared with the standard regimen, neither TBI > 1200 cGy nor the addition of etoposide improves survival after HSCT for ALL.
Author List
Tracey J, Zhang MJ, Thiel E, Sobocinski KA, Eapen MAuthors
Mary Eapen MBBS, DCh, MRCPI, MS Professor in the Medicine department at Medical College of WisconsinMei-Jie Zhang PhD Professor in the Institute for Health and Equity department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AdolescentChild
Child, Preschool
Female
Hematopoietic Stem Cell Transplantation
Humans
Male
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Transplantation Conditioning
Treatment Outcome