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Biol Blood Marrow Transplant. 2015 Mar;21(3):552-8. doi: 10.1016/j.bbmt.2014.12.010. Epub 2014 Dec 17.

Comparison of outcomes of allogeneic transplantation for chronic myeloid leukemia with cyclophosphamide in combination with intravenous busulfan, oral busulfan, or total body irradiation.

Author information

1
Levine Cancer Institute, Carolinas Healthcare System, Charlotte, North Carolina. Electronic address: Heather.T.Johnson@carolinashealthcare.org.
2
Levine Cancer Institute, Carolinas Healthcare System, Charlotte, North Carolina.
3
Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, Wisconsin; Department of Medicine, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin.
4
Department of Medicine, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin.
5
Division of Experimental Medicine, Department of Medicine, Hematology Research Centre, Imperial College of London, London, United Kingdom.
6
Department of Hematology and Oncology, Cleveland Clinic, Cleveland, Ohio.
7
Department of Hematology/Oncology, All Children's Hospital, St Petersburg, Florida.
8
University Hospitals Bristol NHS Trust, Bristol, United Kingdom.
9
Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia.
10
Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
11
Division of Hematology/Oncology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina.
12
Division of Hematology Oncology, UMass Memorial Medical Center, Worcester, Massachusetts.
13
Department of Hematology, University Hospital, Grenoble, France.
14
Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota Medical Center, Minneapolis, Minnesota.
15
Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
16
Division of Hematology and Oncology, Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, Texas.
17
Divison of Hematology, Academische Ziekenhuis Maastricht, Maastricht, Netherlands.
18
Department of Internal Medicine, Stony Brook University Medical Center, Stony Brook, New York.
19
Department of Hematology, Mayo Clinic, Rochester, Minnesota.
20
Department of Oncology, King Faisal Specialist Hospital Center & Research, Riyadh, Saudi Arabia.
21
Department of Medical Oncology, Weill Cornell Medical College, New York, New York.
22
The Ottawa Hospital Blood & Marrow Transplant Program and the Ottawa Hospital Research Institute, Ottawa, ON, Canada.
23
Department of Clinical Haematology and Bone Marrow Transplantation, Royal Melbourne Hospital, Parkville, Victoria, Australia.
24
Division of Hematology/Oncology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
25
Center of Hematologic Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
26
Division of Cancer Medicine, Department of Leukemia, The University of Texas M.D. Anderson Cancer Center, Houston, Texas.
27
Center for Hematologic Malignancies, Oregon Health and Science University, Portland, Oregon.

Abstract

Cyclophosphamide (Cy) in combination with busulfan (Bu) or total body irradiation (TBI) is the most commonly used myeloablative conditioning regimen in patients with chronic myeloid leukemia (CML). We used data from the Center for International Bone Marrow Transplantation Research to compare outcomes in adults who underwent hematopoietic cell transplantation for CML in first chronic phase after myeloablative conditioning with Cy in combination with TBI, oral Bu, or intravenous (i.v.) Bu. Four hundred thirty-eight adults received human leukocyte antigen (HLA)-matched sibling grafts and 235 received well-matched grafts from unrelated donors (URD) from 2000 through 2006. Important differences existed between the groups in distribution of donor relation, exposure to tyrosine kinase inhibitors, and year of transplantation. In multivariate analysis, relapse occurred less frequently among patients receiving i.v. Bu compared with TBI (relative risk [RR], .36; P = .022) or oral Bu (RR, .39; P = .028), but nonrelapse mortality and survival were similar. A significant interaction was detected between donor relation and the main effect in leukemia-free survival (LFS). Among recipients of HLA-identical sibling grafts, but not URD grafts, LFS was better in patients receiving i.v. Bu (RR, .53; P = .025) or oral Bu (RR, .64; P = .017) compared with TBI. In CML in first chronic phase, Cy in combination with i.v. Bu was associated with less relapse than TBI or oral Bu. LFS was better after i.v. or oral Bu compared with TBI.

KEYWORDS:

Busulfan; Chronic myeloid leukemia; Total body irradiation

PMID:
25528388
PMCID:
PMC4329042
DOI:
10.1016/j.bbmt.2014.12.010
[Indexed for MEDLINE]
Free PMC Article

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