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Am J Hematol. 2018 Jun;93(6):778-785. doi: 10.1002/ajh.25091. Epub 2018 Mar 30.

Cyclophosphamide versus etoposide in combination with total body irradiation as conditioning regimen for adult patients with Ph-negative acute lymphoblastic leukemia undergoing allogeneic stem cell transplant: On behalf of the ALWP of the European Society for Blood and Marrow Transplantation.

Author information

1
Wroclaw Medical University, Wroclaw, Poland.
2
Hospital St. Antoine, Paris, France.
3
Acute Leukemia Working Party of the EBMT, Paris office, Hospital St. Antoine, Paris, France.
4
Maria Sklodowska-Curie Memorial Cancer Center, Gliwice, Poland.
5
Hopital St. Louis, Paris, France.
6
Imperial College, Hammersmith Hospital, London, United Kingdom.
7
Helsinki University Central Hospital, Helsinki, Finland.
8
St. István and St. Laszlo Hospital Semmelweis University St. Laszlo Campus, Budapest, Hungary.
9
Université de Lille, 59000, Lille, France.
10
University Hospital Southampton and University of Southampton, Southampton, United Kingdom.
11
Centre Hospitalier Lyon Sud - Service Hematologie, Lyon, France.
12
Deutsche Klinik für Diagnostik KMT Zentrum, Wiesbaden, Germany.
13
University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom.
14
Leicester Royal Infirmary, Leicester, United Kingdom.
15
King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
16
Christie NHS Trust Hospital, Manchester, United Kingdom.
17
University Hospital, Basel, Switzerland.
18
University of Freiburg, Freiburg, Germany.
19
Chaim Sheba Medical Center, Tel-Hashomer, Israel.

Abstract

Allogeneic hematopoietic cell transplantation (alloHCT) with myeloablative conditioning based on total body irradiation (TBI) is widely used for the treatment of adults with acute lymphoblastic leukemia (ALL). TBI is most frequently administered in combination with either cyclophosphamide (Cy/TBI) or etoposide (Vp/TBI). The goal of this study was to retrospectively compare these two regimens. Adult patients with Ph-negative ALL treated with alloHCT in first or second complete remission who received Cy/TBI (n = 1346) or Vp/TBI (n = 152) conditioning were included in the analysis. In a univariate analysis, as compared to Cy/TBI, the use of Vp/TBI was associated with reduced incidence of relapse (17% vs. 30% at 5 years, P = .007), increased rate of leukemia-free survival (60% vs. 50%, P = .04), and improved "graft versus host disease (GVHD) and relapse-free survival" (GRFS, 43% vs. 33%, P = .04). No significant effect could be observed in terms of the incidence of nonrelapse mortality or acute or chronic GVHD. In a multivariate model, the use of Vp/TBI was associated with reduced risk of relapse (HR = 0.62, P = .04) while the effect on other study end-points was not significant. In conclusion, conditioning regimen based on Vp combined with TBI appears more effective for disease control than the combination of Cy with TBI for adult patients with Ph-negative ALL treated with alloHCT.

PMID:
29574915
DOI:
10.1002/ajh.25091
[Indexed for MEDLINE]

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