Comparable long-term outcomes after reduced-intensity conditioning versus myeloablative conditioning allogeneic stem cell transplantation for adult high-risk acute lymphoblastic leukemia in complete remission.

Abstract

The role of reduced-intensity conditioning (RIC) in adult acute lymphoblastic leukemia (ALL) remains unclear because of the small sample size, short follow-up duration, various regimens for conditioning and graft-versus-host disease (GVHD) prophylaxis, and the heterogeneity of selection criteria for transplantation. We compared long-term outcomes of 60 consecutive RIC transplants (fludarabine plus melphalan) with 120 myeloablative conditioning (MAC) transplants (total body irradiation plus cyclophosphamide) for adult high-risk ALL in first or second complete remission. All transplants received a uniform strategy of pretransplant chemotherapy and GVHD prophylaxis. Compared to MAC transplants, RIC transplants had older age (46 years vs. 33 years, P < 0.001) and higher proportions of transplantation using peripheral blood (93.3% vs. 13.3%; P < 0.001) but otherwise showed similar characteristics. After a median follow-up of 67 months, RIC transplants showed comparable nonrelapse mortality (21.2% vs. 24.3%) and disease-free survival (50.8% vs. 54.9%) to MAC transplants, although relapse risk was higher (34.2% vs. 26.4%; HR, 2.07; P = 0.019) in multivariate analysis. Other independent factors associated with better outcomes were the presence of chronic GVHD and transplantation in first complete remission. Interestingly, the negative impact of RIC on relapse risk was seen only for Philadelphia-positive ALL transplants (32.7% vs. 19.6%; HR, 3.46; P = 0.020), while no difference was found between RIC and MAC for Philadelphia-negative ALL transplants (35.0% vs. 32.1%; HR, 1.39; P = 0.429). RIC can be considered as a reasonable choice for providing a sufficient long-term graft-versus-leukemia effect for adult high-risk ALL patients ineligible for MAC.

• Authors: Ki-Seong Eom, Seung-Hwan Shin, Jae-Ho Yoon, Seung-Ah Yahng, Sung-Eun Lee, Byung-Sik Cho, Yoo-Jin Kim, Hee-Je Kim, Chang-Ki Min, Dong-Wook Kim, Jong-Wook Lee, Woo-Sung Min, Chong-Won Park, Seok Lee
• Journal: American journal of hematology (Am J Hematol) Vol. 88 Issue 8 Pg. 634-41 (Aug 2013) ISSN: 1096-8652 [Electronic] United States
• PMID: 23620000 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2013 Wiley Periodicals, Inc.

Chemical References

• Myeloablative Agonists
• Cyclophosphamide

Topics

• Adolescent
• Adult
• Cyclophosphamide (administration & dosage)
• Disease-Free Survival
• Female
• Follow-Up Studies
• Graft vs Host Disease (mortality, prevention & control, therapy)
• Humans
• Male
• Middle Aged
• Myeloablative Agonists (administration & dosage)
• Precursor Cell Lymphoblastic Leukemia-Lymphoma (mortality, therapy)
• Remission Induction
• Retrospective Studies
• Risk Factors
• Stem Cell Transplantation
• Survival Rate
• Transplantation Conditioning (methods)
• Transplantation, Homologous
• Whole-Body Irradiation (methods)