Yonsei medical journal · 2020
Reduced-Intensity Conditioning with Busulfan and Fludarabine for Allogeneic Hematopoietic Stem Cell Transplantation in Acute Lymphoblastic Leukemia.
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Lee Seung Shin, Jung Sung Hoon, Do Young Rok, Kim Dae Sik, Lee Ji Hyun, Park Han Seung, Moon Joon Ho, Yi Jun Ho, Park Yong, Koh Youngil, Yhim Ho Young, Choi Yunsuk, Mun Yeung Chul, Lee Won Sik, Lee Seok, Yang Deok Hwan, Korean Adult Acute Lymphoblastic Leukemia Working Party
Аннотация
PURPOSE: Allogeneic hematopoietic stem cell transplantation (HSCT) with optimal conditioning has helped better long-term survival in acute lymphoblastic leukemia (ALL). This study investigated the efficacy and safety of reduced-intensity conditioning (RIC) with busulfan and fludarabine in adult ALL patients unfit for myeloablation.
MATERIALS AND METHODS: Records of 78 patients who underwent HSCT with RIC consisting of 3.2 mg/kg/day of busulfan for 2 or 3 days and 30 mg/m²/day of fludarabine for 5 or 6 days were analyzed.
RESULTS: The median age at diagnosis was 49 years. Over a median follow-up of 22 months, 2-year estimates of relapse-free survival (RFS) and overall survival were 57.4% and 68.7%, respectively. Multivariate analysis showed a trend of improved RFS in patients with chronic graft-versus-host disease (GVHD) (hazard ratio, 0.53; 95% confidence interval, 0.26-1.08; p=0.080). The cumulative incidences of relapse and non-relapse mortality were 42.9% and 19.6%, respectively and one case of central nervous system relapse was noted. No hepatic veno-occlusive disease was reported. Grade II-IV acute GVHD and any grade chronic GVHD occurred in 21.1% and 41.7%, respectively.
CONCLUSION: RIC with busulfan and fludarabine is an effective and safe conditioning regimen for adult ALL patients unfit for myeloablation.
MATERIALS AND METHODS: Records of 78 patients who underwent HSCT with RIC consisting of 3.2 mg/kg/day of busulfan for 2 or 3 days and 30 mg/m²/day of fludarabine for 5 or 6 days were analyzed.
RESULTS: The median age at diagnosis was 49 years. Over a median follow-up of 22 months, 2-year estimates of relapse-free survival (RFS) and overall survival were 57.4% and 68.7%, respectively. Multivariate analysis showed a trend of improved RFS in patients with chronic graft-versus-host disease (GVHD) (hazard ratio, 0.53; 95% confidence interval, 0.26-1.08; p=0.080). The cumulative incidences of relapse and non-relapse mortality were 42.9% and 19.6%, respectively and one case of central nervous system relapse was noted. No hepatic veno-occlusive disease was reported. Grade II-IV acute GVHD and any grade chronic GVHD occurred in 21.1% and 41.7%, respectively.
CONCLUSION: RIC with busulfan and fludarabine is an effective and safe conditioning regimen for adult ALL patients unfit for myeloablation.
Предметные рубрики MeSH
Acute DiseaseAdolescentAdultAgedBusulfanFemaleGraft vs Host DiseaseHematopoietic Stem Cell TransplantationHumansKaplan-Meier EstimateMiddle AgedMultivariate AnalysisPrecursor Cell Lymphoblastic Leukemia-LymphomaProportional Hazards ModelsRecurrenceTransplantation ConditioningTransplantation, HomologousVidarabineYoung Adult