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. 2010 Jul 22;116(3):366-74.
doi: 10.1182/blood-2010-01-264077. Epub 2010 Apr 19.

The outcome of full-intensity and reduced-intensity conditioning matched sibling or unrelated donor transplantation in adults with Philadelphia chromosome-negative acute lymphoblastic leukemia in first and second complete remission

David I Marks  1 , Tao Wang, Waleska S Pérez, Joseph H Antin, Edward Copelan, Robert Peter Gale, Biju George, Vikas Gupta, Joerg Halter, H Jean Khoury, Thomas R Klumpp, Hillard M Lazarus, Victor A Lewis, Philip McCarthy, David A Rizzieri, Mitchell Sabloff, Jeff Szer, Martin S Tallman, Daniel J Weisdorf
Affiliations

The outcome of full-intensity and reduced-intensity conditioning matched sibling or unrelated donor transplantation in adults with Philadelphia chromosome-negative acute lymphoblastic leukemia in first and second complete remission

David I Marks et al. Blood. .

Abstract

We examined the efficacy of reduced-intensity conditioning (RIC) and compared outcomes of 93 patients older than 16 years after RIC with 1428 patients receiving full-intensity conditioning for allografts using sibling and unrelated donors for Philadelphia-negative acute lymphoblastic leukemia (ALL) in first or second complete remission. RIC conditioning included busulfan 9 mg/kg or less (27), melphalan 150 mg/m(2) or less (23), low-dose total body irradiation (TBI; 36), and others (7). The RIC group was older (median 45 vs 28 years, P < .001) and more received peripheral blood grafts (73% vs 43%, P < .001) but had similar other prognostic factors. The RIC versus full-intensity conditioning groups had slightly, but not significantly, less acute grade II-IV graft-versus-host disease (39% vs 46%) and chronic graft-versus-host disease (34% vs 42%), yet similar transplantation-related mortality. RIC led to slightly more relapse (35% vs 26%, P = .08) yet similar age-adjusted survival (38% vs 43%, P = .39). Multivariate analysis showed that conditioning intensity did not affect transplantation-related mortality (P = .92) or relapse risk (P = .14). Multivariate analysis demonstrated significantly improved overall survival with: Karnofsky performance status more than 80, first complete remission, lower white blood count, well-matched unrelated or sibling donors, transplantation since 2001, age younger than 30 years, and conditioning with TBI, but no independent impact of conditioning intensity. RIC merits further investigation in prospective trials of adult ALL.

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Figures

Figure 1
Figure 1
Cumulative incidence of relapse of RIC and FI for adult Ph-ALL.
Figure 2
Figure 2
Cumulative incidence of treatment-related mortality of RIC and FI for adult Ph-ALL.
Figure 3
Figure 3
Adjusted probability of DFS of RIC and FI for adult Ph-ALL.
Figure 4
Figure 4
Adjusted probability of OS of RIC and FI for adult Ph-ALL.
See this image and copyright information in PMC

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References

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