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Comparison of Cyclophosphamide Combined with Total Body Irradiation, Oral Busulfan, or Intravenous Busulfan for Allogeneic Hematopoietic Cell Transplantation in Adults with Acute Lymphoblastic Leukemia.
Biol Blood Marrow Transplant. 2016 12; 22(12):2194-2200.BB

Abstract

We conducted a retrospective analysis to compare outcomes in adult patients with acute lymphoblastic leukemia (ALL) who underwent allogeneic hematopoietic cell transplantation (allo-HCT) with conditioning regimens containing cyclophosphamide (CY) in combination with total body irradiation (TBI), oral busulfan (p.o. BU), or intravenous busulfan (i.v. BU). We used data for January 2000 to December 2012 from the Transplant Registry Unified Management Program of the Japan Society of Hematopoietic Cell Transplantation. We identified 2130 patients treated with TBI/CY (n = 2028), p.o. BU/CY (n = 60), or i.v. BU/CY (n = 42). Two-year overall survival (OS) and 2-year relapse-free survival rates were 69.0% and 62.1%, respectively, in the TBI/CY group, 55.9% and 54.2% in the p.o. BU/CY group, and 71.0% and 46.8% in the i.v. BU/CY group. In multivariate analysis, compared with TBI/CY, p.o. BU/CY, but not i.v. BU/CY, was associated with lower OS (hazard ratio [HR], 1.46; P = .047) and a higher incidence of sinusoidal obstruction syndrome (HR, 3.36; P = .030). No between-group differences were seen in the incidence of nonrelapse mortality, relapse, acute graft-versus-host disease (GVHD), or chronic GVHD. We suggest that i.v. BU/CY might be a possible alternative allo-HCT conditioning regimen for adults with ALL who are not suitable for TBI.

Authors+Show Affiliations

Department of Hematology, Tokyo Women's Medical University, Tokyo, Japan. Electronic address: kmitsuhashi@twmu.ac.jp.Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan.Department of Hematology, Sapporo Hokuyu Hospital, Sapporo, Japan.Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan; Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan.Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan.Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan.Department of Hematology, Kanagawa Cancer Center, Yokohama, Japan.Department of Hematology and Oncology, Tokai University School of Medicine, Isehara, Japan.Division of Molecular Therapy, Advanced Clinical Research Center, Institute of Medical Science, The University of Tokyo, Tokyo, Japan.Department of Hematology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan.Department of Cell Therapy and Transplantation Medicine, The University of Tokyo, Tokyo, Japan.Department of Hematology, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan.Department of Cell Processing and Transfusion, Institute of Medical Science, The University of Tokyo, Tokyo, Japan.Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Aichi, Japan.Department of Hematology, Fujita Health University Hospital, Toyoake, Japan.Department of Hematology, Tokyo Women's Medical University, Tokyo, Japan.No affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

27638362

Citation

Mitsuhashi, Kenjiro, et al. "Comparison of Cyclophosphamide Combined With Total Body Irradiation, Oral Busulfan, or Intravenous Busulfan for Allogeneic Hematopoietic Cell Transplantation in Adults With Acute Lymphoblastic Leukemia." Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation, vol. 22, no. 12, 2016, pp. 2194-2200.
Mitsuhashi K, Kako S, Shigematsu A, et al. Comparison of Cyclophosphamide Combined with Total Body Irradiation, Oral Busulfan, or Intravenous Busulfan for Allogeneic Hematopoietic Cell Transplantation in Adults with Acute Lymphoblastic Leukemia. Biol Blood Marrow Transplant. 2016;22(12):2194-2200.
Mitsuhashi, K., Kako, S., Shigematsu, A., Atsuta, Y., Doki, N., Fukuda, T., Kanamori, H., Onizuka, M., Takahashi, S., Ozawa, Y., Kurokawa, M., Inoue, Y., Nagamura-Inoue, T., Morishima, Y., Mizuta, S., & Tanaka, J. (2016). Comparison of Cyclophosphamide Combined with Total Body Irradiation, Oral Busulfan, or Intravenous Busulfan for Allogeneic Hematopoietic Cell Transplantation in Adults with Acute Lymphoblastic Leukemia. Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation, 22(12), 2194-2200. https://doi.org/10.1016/j.bbmt.2016.09.007
Mitsuhashi K, et al. Comparison of Cyclophosphamide Combined With Total Body Irradiation, Oral Busulfan, or Intravenous Busulfan for Allogeneic Hematopoietic Cell Transplantation in Adults With Acute Lymphoblastic Leukemia. Biol Blood Marrow Transplant. 2016;22(12):2194-2200. PubMed PMID: 27638362.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of Cyclophosphamide Combined with Total Body Irradiation, Oral Busulfan, or Intravenous Busulfan for Allogeneic Hematopoietic Cell Transplantation in Adults with Acute Lymphoblastic Leukemia. AU - Mitsuhashi,Kenjiro, AU - Kako,Shinichi, AU - Shigematsu,Akio, AU - Atsuta,Yoshiko, AU - Doki,Noriko, AU - Fukuda,Takahiro, AU - Kanamori,Heiwa, AU - Onizuka,Makoto, AU - Takahashi,Satoshi, AU - Ozawa,Yukiyasu, AU - Kurokawa,Mineo, AU - Inoue,Yoshiko, AU - Nagamura-Inoue,Tokiko, AU - Morishima,Yasuo, AU - Mizuta,Shuichi, AU - Tanaka,Junji, AU - ,, Y1 - 2016/09/13/ PY - 2016/05/24/received PY - 2016/09/06/accepted PY - 2016/10/26/pubmed PY - 2018/1/27/medline PY - 2016/9/18/entrez KW - Acute lymphoblastic leukemia KW - Allogeneic hematopoietic cell transplantation KW - Busulfan KW - Total body irradiation SP - 2194 EP - 2200 JF - Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation JO - Biol Blood Marrow Transplant VL - 22 IS - 12 N2 - We conducted a retrospective analysis to compare outcomes in adult patients with acute lymphoblastic leukemia (ALL) who underwent allogeneic hematopoietic cell transplantation (allo-HCT) with conditioning regimens containing cyclophosphamide (CY) in combination with total body irradiation (TBI), oral busulfan (p.o. BU), or intravenous busulfan (i.v. BU). We used data for January 2000 to December 2012 from the Transplant Registry Unified Management Program of the Japan Society of Hematopoietic Cell Transplantation. We identified 2130 patients treated with TBI/CY (n = 2028), p.o. BU/CY (n = 60), or i.v. BU/CY (n = 42). Two-year overall survival (OS) and 2-year relapse-free survival rates were 69.0% and 62.1%, respectively, in the TBI/CY group, 55.9% and 54.2% in the p.o. BU/CY group, and 71.0% and 46.8% in the i.v. BU/CY group. In multivariate analysis, compared with TBI/CY, p.o. BU/CY, but not i.v. BU/CY, was associated with lower OS (hazard ratio [HR], 1.46; P = .047) and a higher incidence of sinusoidal obstruction syndrome (HR, 3.36; P = .030). No between-group differences were seen in the incidence of nonrelapse mortality, relapse, acute graft-versus-host disease (GVHD), or chronic GVHD. We suggest that i.v. BU/CY might be a possible alternative allo-HCT conditioning regimen for adults with ALL who are not suitable for TBI. SN - 1523-6536 UR - https://www.unboundmedicine.com/medline/citation/27638362/Comparison_of_Cyclophosphamide_Combined_with_Total_Body_Irradiation_Oral_Busulfan_or_Intravenous_Busulfan_for_Allogeneic_Hematopoietic_Cell_Transplantation_in_Adults_with_Acute_Lymphoblastic_Leukemia_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1083-8791(16)30333-0 DB - PRIME DP - Unbound Medicine ER -