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.
Sebastian GiebelMyriam LabopinGerard SocièMahmoud AljurfUrpu SalmenniemiHélène Labussière-WalletMicha SrourNicolaus M KrögerMohsen Al ZahraniBruno LiourePéter ReményiMutlu AratJean Henri BourhisGrzegorz HelbigAbdelghani TbakhiEdouard ForcadeAnne HuynhEolia BrissotAlexandros SpirydonidisBipin P SavaniZinaida PerićArnon NaglerFlorent MalardPublished in: Bone marrow transplantation (2023)
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.
Keyphrases
- traumatic brain injury
- acute lymphoblastic leukemia
- severe traumatic brain injury
- allogeneic hematopoietic stem cell transplantation
- stem cell transplantation
- prognostic factors
- mild traumatic brain injury
- free survival
- high dose
- end stage renal disease
- low dose
- bone marrow
- newly diagnosed
- ejection fraction
- liver failure
- stem cells
- chronic kidney disease
- peritoneal dialysis
- coronary artery disease
- radiation therapy
- cardiovascular disease
- cardiovascular events
- cell proliferation
- systemic lupus erythematosus
- data analysis
- respiratory failure
- cell death
- adipose tissue
- signaling pathway