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Comparable long‐term outcomes after reduced‐intensity conditioning versus myeloablative conditioning allogeneic stem cell transplantation for adult high‐risk acute lymphoblastic leukemia in complete remission
Author(s) -
Eom KiSeong,
Shin SeungHwan,
Yoon JaeHo,
Yahng SeungAh,
Lee SungEun,
Cho ByungSik,
Kim YooJin,
Kim HeeJe,
Min ChangKi,
Kim DongWook,
Lee JongWook,
Min WooSung,
Park ChongWon,
Lee Seok
Publication year - 2013
Publication title -
american journal of hematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.456
H-Index - 105
eISSN - 1096-8652
pISSN - 0361-8609
DOI - 10.1002/ajh.23465
Subject(s) - medicine , fludarabine , melphalan , total body irradiation , transplantation , cyclophosphamide , gastroenterology , surgery , hematopoietic stem cell transplantation , conditioning , oncology , chemotherapy , statistics , mathematics
The role of reduced‐intensity conditioning (RIC) in adult acute lymphoblastic leukemia (ALL) remains unclear because of the small sample size, short follow‐up duration, various regimens for conditioning and graft‐versus‐host disease (GVHD) prophylaxis, and the heterogeneity of selection criteria for transplantation. We compared long‐term outcomes of 60 consecutive RIC transplants (fludarabine plus melphalan) with 120 myeloablative conditioning (MAC) transplants (total body irradiation plus cyclophosphamide) for adult high‐risk ALL in first or second complete remission. All transplants received a uniform strategy of pretransplant chemotherapy and GVHD prophylaxis. Compared to MAC transplants, RIC transplants had older age (46 years vs. 33 years, P < 0.001) and higher proportions of transplantation using peripheral blood (93.3% vs. 13.3%; P < 0.001) but otherwise showed similar characteristics. After a median follow‐up of 67 months, RIC transplants showed comparable nonrelapse mortality (21.2% vs. 24.3%) and disease‐free survival (50.8% vs. 54.9%) to MAC transplants, although relapse risk was higher (34.2% vs. 26.4%; HR, 2.07; P = 0.019) in multivariate analysis. Other independent factors associated with better outcomes were the presence of chronic GVHD and transplantation in first complete remission. Interestingly, the negative impact of RIC on relapse risk was seen only for Philadelphia‐positive ALL transplants (32.7% vs. 19.6%; HR, 3.46; P = 0.020), while no difference was found between RIC and MAC for Philadelphia‐negative ALL transplants (35.0% vs. 32.1%; HR, 1.39; P = 0.429). RIC can be considered as a reasonable choice for providing a sufficient long‐term graft‐versus‐leukemia effect for adult high‐risk ALL patients ineligible for MAC. Am. J. Hematol. 88:634–641, 2013. © 2013 Wiley Periodicals, Inc.