Thiotepa, busulfan and fludarabine conditioning-regimen is a promising approach for older adult patients with acute lymphoblastic leukemia treated with allogeneic stem cell transplantation.
Anne BanetAli BazarbachiMyriam LabopinNicolas StockerRémy DuléryFlorent MalardZoé Van de WyngaertAlexis GenthonMara MemoliOllivier LegrandAgnes BonninTounes LedraaRamdane BelhocineSimona SestiliJean El-CheikhFlorent MalardEolia BrissotPublished in: Bone marrow transplantation (2022)
For acute lymphoblastic leukemia (ALL) patients, total body irradiation (TBI)- based conditioning regimens are the first choice specially in young population. However, several studies have shown an equivalence in clinical outcomes with thiotepa-based conditioning regimen. We performed a retrospective study to evaluate the outcome of adult ALL patients who received allogeneic hematopoietic stem cell transplantation (allo-HCT) with a thiotepa-busulfan-fludarabine (TBF) myeloablative conditioning regimen with reduced toxicity. Fifty-five patients received a TBF regimen. The median age of the patients was 51 years (range, 17 to 72.4). Most patients had a diagnosis of B-ALL (93%) with 7% having T-ALL. Two - and 5-year overall survival was 73.2% and 64%, respectively. At 2 years, leukemia-free survival and GVHD-free, relapse-free survival were 59.5% and 57.6%, and at 5 years, 53.4% and 51.8%, respectively. The 5-year non-relapse mortality was 15%. The day 180 cumulative incidence (CI) of grade II-IV acute GVHD and grade III-IV acute GVHD were 38.2% and 5.5%, respectively. At 2 years, the CI of chronic GVHD and extensive chronic GVHD was 16.9% and 1.9%, respectively. Our study results do suggest that using TBF as the conditioning regimen in adult ALL patients is a promising option with acceptable toxicity.
Keyphrases
- allogeneic hematopoietic stem cell transplantation
- acute lymphoblastic leukemia
- end stage renal disease
- stem cell transplantation
- free survival
- newly diagnosed
- ejection fraction
- chronic kidney disease
- peritoneal dialysis
- acute myeloid leukemia
- prognostic factors
- type diabetes
- traumatic brain injury
- low dose
- intensive care unit
- oxidative stress
- patient reported outcomes
- cardiovascular events
- signaling pathway
- hematopoietic stem cell