Scientific Publications Database

Article Title: Intravenous Busulfan Compared with Total Body Irradiation Pretransplant Conditioning for Adults with Acute Lymphoblastic Leukemia
Authors: Kebriaei, Partbw; Anasetti, Claudio; Zhang, Mei-Jie; Wang, Hai-Lin; Aldoss, Ibrahim; de Lima, Marcos; Khoury, H. Jean; Sandmaier, Brenda M.; Horowitz, Mary M.; Artz, Andrew; Bejanyan, Nelli; Ciurea, Stefan; Lazarus, Hillard M.; Gale, Robert Peter; Litzow, Mark; Bredeson, Christopher; Seftel, Matthew D.; Pulsipher, Michael A.; Boelens, Jaap-Jan; Alvarnas, Joseph; Champlin, Richard; Forman, Stephen; Pullarkat, Vinod; Weisdorf, Daniel; Marks, David L.
Journal: BIOLOGY OF BLOOD AND MARROW TRANSPLANTATION Volume 24 Issue 4
Date of Publication:2018
Abstract:
Total body irradiation (TBI) has been included in standard conditioning for acute lymphoblastic leukemia (ALL) before hematopoietic cell transplantation (HCT). Non-TBI regimens have incorporated busulfan (Bu) to decrease toxicity. This retrospective study analyzed TBI and Bu on outcomes of ALL patients 18-60 years old, in first or second complete remission (CR), undergoing HLA-compatible sibling, related, or unrelated donor HCT, who reported to the Center for International Blood and Marrow Transplant Research from 2005 to 2014. TBI plus etoposide (25%) or cyclophosphamide (75%) was used in 819 patients, and intravenous Bu plus fludarabine (41%), clofarabine (30%), cyclophosphamide (15%), or melphalan (13%) was used in 299 patients. Bu containing regimens were analyzed together, since no significant differences for patient outcomes were noted between them. Bu patients were older, with better performance status; took longer to achieve first CR and receive HCT; were treated more recently; and were more likely to receive peripheral blood grafts, antithymocyte globulin, or tyrosine kinase inhibitors. With median follow-up of 3.6 years for Bu and 5.3 years for TBI, adjusted 3-year outcomes showed treatment-related mortality Bu 19% versus TBI 25% (P=.04); relapse Bu 37% versus TBI 28% (P=.007); disease-free survival (DFS) Bu 45% versus TBI 48% (P=.35); and overall survival (OS) Bu 57% versus TBI 53% (P=.35). In multivariate analysis, Bu patients had higher risk of relapse (relative risk, 1.46; 95% confidence interval, 1.15 to 1.85; P=.002) compared with TBI patients. Despite the higher relapse, Bu-containing conditioning led to similar OS and DFS following HCT for ALL. (C) 2018 Published by Elsevier Inc. on behalf of the American Society for Blood and Marrow Transplantation.