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Comparison of a fludarabine and melphalan combination-based reduced toxicity conditioning with myeloablative conditioning by radiation and/or busulfan in acute myeloid leukemia in Japanese children and adolescents.
Pediatr Blood Cancer. 2015 May; 62(5):883-9.PB

Abstract

BACKGROUND

The relative efficacy of allogeneic hematopoietic cell transplantation (allo-HCT) after reduced toxicity conditioning (RTC) compared with standard myeloablative conditioning (MAC) in pediatric patients with acute myeloid leukemia (AML) has not been studied extensively. To address whether RTC is a feasible approach for pediatric patients with AML in remission, we performed a retrospective investigation of the outcomes of the first transplant in patients who had received an allo-HCT after RTC or standard MAC, using nationwide registration data collected between 2000 and 2011 in Japan.

PROCEDURE

We compared a fludarabine (Flu) and melphalan (Mel)-based regimen (RTC; n = 34) with total body irradiation (TBI) and/or busulfan (Bu)-based conditioning (MAC; n = 102) in demographic- and disease-criteria-matched childhood and adolescent patients with AML in first or second complete remission (CR1/CR2).

RESULTS

The incidence of engraftment, early complications, grade II-IV acute graft-versus-host disease (GVHD), and chronic GVHD were similar in each conditioning group. The risk of relapse (25% vs. 26%) and non-relapse mortality (13% vs. 11%) after 3 years did not differ between these groups, and univariate and multivariate analyses demonstrated that the 3-year overall survival (OS) rates after Flu/Mel-RTC and MAC were comparable (mean, 72% [range, 51-85%] and 68% [range, 58-77%], respectively).

CONCLUSIONS

The results suggest that the Flu/Mel-RTC regimen is a clinically acceptable conditioning strategy for childhood and adolescent patients with AML in remission. Although this retrospective, registry-based analysis has several limitations, RTC deserves to be further investigated in prospective trials.

Authors+Show Affiliations

Department of Pediatrics, Kyoto Prefectural University of Medicine, Kyoto, Japan; Division of Pediatrics, Matsushita Memorial Hospital, Moriguchi, Japan.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

25545836

Citation

Ishida, Hiroyuki, et al. "Comparison of a Fludarabine and Melphalan Combination-based Reduced Toxicity Conditioning With Myeloablative Conditioning By Radiation And/or Busulfan in Acute Myeloid Leukemia in Japanese Children and Adolescents." Pediatric Blood & Cancer, vol. 62, no. 5, 2015, pp. 883-9.
Ishida H, Adachi S, Hasegawa D, et al. Comparison of a fludarabine and melphalan combination-based reduced toxicity conditioning with myeloablative conditioning by radiation and/or busulfan in acute myeloid leukemia in Japanese children and adolescents. Pediatr Blood Cancer. 2015;62(5):883-9.
Ishida, H., Adachi, S., Hasegawa, D., Okamoto, Y., Goto, H., Inagaki, J., Inoue, M., Koh, K., Yabe, H., Kawa, K., Kato, K., Atsuta, Y., & Kudo, K. (2015). Comparison of a fludarabine and melphalan combination-based reduced toxicity conditioning with myeloablative conditioning by radiation and/or busulfan in acute myeloid leukemia in Japanese children and adolescents. Pediatric Blood & Cancer, 62(5), 883-9. https://doi.org/10.1002/pbc.25389
Ishida H, et al. Comparison of a Fludarabine and Melphalan Combination-based Reduced Toxicity Conditioning With Myeloablative Conditioning By Radiation And/or Busulfan in Acute Myeloid Leukemia in Japanese Children and Adolescents. Pediatr Blood Cancer. 2015;62(5):883-9. PubMed PMID: 25545836.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of a fludarabine and melphalan combination-based reduced toxicity conditioning with myeloablative conditioning by radiation and/or busulfan in acute myeloid leukemia in Japanese children and adolescents. AU - Ishida,Hiroyuki, AU - Adachi,Souichi, AU - Hasegawa,Daiichiro, AU - Okamoto,Yasuhiro, AU - Goto,Hiroaki, AU - Inagaki,Jiro, AU - Inoue,Masami, AU - Koh,Katsuyoshi, AU - Yabe,Hiromasa, AU - Kawa,Keisei, AU - Kato,Koji, AU - Atsuta,Yoshiko, AU - Kudo,Kazuko, Y1 - 2014/12/24/ PY - 2014/07/04/received PY - 2014/11/11/accepted PY - 2014/12/30/entrez PY - 2014/12/30/pubmed PY - 2015/7/8/medline KW - acute myeloid leukemia KW - childhood KW - hematopoietic stem cell transplantation KW - melphalan KW - reduced intensity conditioning KW - reduced toxicity conditioning SP - 883 EP - 9 JF - Pediatric blood & cancer JO - Pediatr Blood Cancer VL - 62 IS - 5 N2 - BACKGROUND: The relative efficacy of allogeneic hematopoietic cell transplantation (allo-HCT) after reduced toxicity conditioning (RTC) compared with standard myeloablative conditioning (MAC) in pediatric patients with acute myeloid leukemia (AML) has not been studied extensively. To address whether RTC is a feasible approach for pediatric patients with AML in remission, we performed a retrospective investigation of the outcomes of the first transplant in patients who had received an allo-HCT after RTC or standard MAC, using nationwide registration data collected between 2000 and 2011 in Japan. PROCEDURE: We compared a fludarabine (Flu) and melphalan (Mel)-based regimen (RTC; n = 34) with total body irradiation (TBI) and/or busulfan (Bu)-based conditioning (MAC; n = 102) in demographic- and disease-criteria-matched childhood and adolescent patients with AML in first or second complete remission (CR1/CR2). RESULTS: The incidence of engraftment, early complications, grade II-IV acute graft-versus-host disease (GVHD), and chronic GVHD were similar in each conditioning group. The risk of relapse (25% vs. 26%) and non-relapse mortality (13% vs. 11%) after 3 years did not differ between these groups, and univariate and multivariate analyses demonstrated that the 3-year overall survival (OS) rates after Flu/Mel-RTC and MAC were comparable (mean, 72% [range, 51-85%] and 68% [range, 58-77%], respectively). CONCLUSIONS: The results suggest that the Flu/Mel-RTC regimen is a clinically acceptable conditioning strategy for childhood and adolescent patients with AML in remission. Although this retrospective, registry-based analysis has several limitations, RTC deserves to be further investigated in prospective trials. SN - 1545-5017 UR - https://www.unboundmedicine.com/medline/citation/25545836/Comparison_of_a_fludarabine_and_melphalan_combination_based_reduced_toxicity_conditioning_with_myeloablative_conditioning_by_radiation_and/or_busulfan_in_acute_myeloid_leukemia_in_Japanese_children_and_adolescents_ L2 - https://doi.org/10.1002/pbc.25389 DB - PRIME DP - Unbound Medicine ER -