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. 2013 Feb;19(2):255-9.
doi: 10.1016/j.bbmt.2012.09.019. Epub 2012 Oct 3.

Transplantation conditioning regimens and outcomes after allogeneic hematopoietic cell transplantation in children and adolescents with acute lymphoblastic leukemia

James Tracey  1 , Mei-Jie Zhang, Elizabeth Thiel, Kathleen A Sobocinski, Mary Eapen
Affiliations

Transplantation conditioning regimens and outcomes after allogeneic hematopoietic cell transplantation in children and adolescents with acute lymphoblastic leukemia

James Tracey et al. Biol Blood Marrow Transplant. 2013 Feb.

Abstract

Relapse is common after hematopoietic stem cell transplantation (HSCT) for acute lymphoblastic leukemia (ALL). Although 1200 cGy total body irradiation (TBI) and cyclophosphamide (Cy) is the standard conditioning regimen, attempts to reduce relapse have led to the addition of a second chemotherapeutic agent and/or higher dose of TBI. We examined HSCT outcomes in patients age <18 years with ALL, in second or subsequent remission or in relapse at transplantation. Most transplantations were performed with the patient in remission. Patients received grafts from an HLA-matched sibling or unrelated donor. Four treatment groups were created: (1) Cy + TBI ≤ 1200 cGy (n = 304), (2) Cy + etoposide + TBI ≤ 1200 cGy (n = 108), (3) Cy + TBI ≥ 1300 cGy (n = 327), and (4) Cy + etoposide + TBI ≥ 1300 cGy (n = 26). Neither TBI > 1200 cGy nor the addition of etoposide resulted in fewer relapses. The 5-year probability of relapse was 30% for group 1, 28% for group 2, 35% for group 3, and 31% for group 4. However, transplantation-related mortality was higher (35% versus 25%, P = .02) and overall survival lower (36% versus 48%, P = .03) in group 4 compared with group 3. Our findings indicate that compared with the standard regimen, neither TBI > 1200 cGy nor the addition of etoposide improves survival after HSCT for ALL.

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Figures

Figure 1
Figure 1
The probabilities of relapse by transplant conditioning regimen: Group 1: Cy + TBI ≤ 1200 cGy; Group 2: Cy + etoposide + TBI ≤ 1200 cGy; Group 3: Cy + TBI ≥ 1300 cGy; Group 4: Cy + etoposide + TBI ≥1300 cGy
Figure 2
Figure 2
The probabilities of transplant-related mortality by transplant conditioning regimen: Group 1: Cy + TBI ≤ 1200 cGy; Group 2: Cy + etoposide + TBI ≤ 1200 cGy; Group 3: Cy + TBI ≥ 1300 cGy; Group 4: Cy + etoposide + TBI ≥1300 cGy
Figure 3
Figure 3
The probabilities of overall survival by transplant conditioning regimen adjusted for patient age, duration of first complete remission, disease status at transplant and donor HLA-match: Group 1: Cy + TBI ≤ 1200 cGy; Group 2: Cy + etoposide + TBI ≤ 1200 cGy; Group 3: Cy + TBI ≥ 1300 cGy; Group 4: Cy + etoposide + TBI ≥1300 cGy
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