Comparison of reduced-intensity conditioning regimens in patients with acute lymphoblastic leukemia > 45 years undergoing allogeneic stem cell transplantation-a retrospective study by the Acute Leukemia Working Party of EBMT

Z. Peric*, M. Labopin, C. Peczynski, E. Polge, J. Cornelissen, B. Carpenter, M. Potter, R. Malladi, J. Byrne, H. Schouten, N. Fegueux, G. Socie, M. Rovira, J. Kuball, M. Gilleece, S. Giebel, A. Nagler, M. Mohty

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

4 Citations (Web of Science)

Abstract

The optimal reduced-intensity conditioning (RIC) for patients with acute lymphoblastic leukemia (ALL) undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains unclear. We retrospectively analyzed 417 patients > 45 years with ALL in first complete remission who underwent a matched sibling or unrelated allo-HSCT and compared outcomes between fludarabine/busulfan (FLUBU, n = 127), fludarabine/melphalan (FLUMEL, n = 190), and fludarabine-TBI (FLUTBI, n = 100) conditioning. At 2 years, there were no differences between the groups in terms of cumulative incidence (CI) of relapse (40% for FLUBU vs 36% for FLUMEL vs 41% for FLUTBI, p = 0.21); transplant-related mortality (TRM) (18% for FLUBU, 22% for FLUMEL, 14% for FLUTBI, p = 0.09); overall survival (55% for FLUBU, 50% for FLUMEL, 60% for FLUTBI, p = 0.62) or leukemia-free survival (43% for FLUBU, 42% for FLUMEL, 45% for FLUTBI, p = 0.99), but GVHD-relapse-free survival was significantly lower in the FLUTBI group than FLUBU and FLUMEL group (18% vs 35% vs 28%, p = 0.02). However, this difference was lost in the multivariate analysis when adjusted for the in vivo T-cell depletion. Finally, the FLUMEL regimen was shown to be an independent risk factor for a higher TRM (HR 1.97, 95% CI 1.05-3.72, p = 0.04). We conclude that the three most popular RIC regimens yield similar transplant outcomes.
Original languageEnglish
Pages (from-to)1560-1569
Number of pages10
JournalBone Marrow Transplantation
Volume55
Issue number8
DOIs
Publication statusPublished - 1 Aug 2020

Keywords

  • 1st complete remission
  • adult patients
  • bone-marrow
  • european-group
  • free survival
  • minimal residual disease
  • peripheral-blood
  • ph plus
  • relapse risk
  • versus-host-disease
  • ADULT PATIENTS
  • FREE SURVIVAL
  • BONE-MARROW
  • PERIPHERAL-BLOOD
  • VERSUS-HOST-DISEASE
  • 1ST COMPLETE REMISSION
  • EUROPEAN-GROUP
  • PH PLUS
  • RELAPSE RISK
  • MINIMAL RESIDUAL DISEASE

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