Open AccessPS956 A MULTICENTER, RETROSPECTIVE STUDY TO EVALUATE EFFICACY AND SAFETY OF BUSULFAN/FLUDARABINE CONDITIONING FOR ALLOGENEIC STEM CELL TRANSPLANTATION IN ADULT PATIENTS WITH ACUTE LYMPHOBLASTIC LEUKEMIA
Author(s) -
Lee S.S.,
Jung S.H.,
Heo M.H.,
Kim D.S.,
Lee J.H.,
Park H.S.,
Lee Y.J.,
Yi J.H.,
Kang K.W.,
Koh Y.,
Yhim H.Y.,
Jo J.C.,
Mun Y.C.,
Lee W.S.,
Yang D.H.,
Lee S.
Publication year - 2019
Publication title -
hemasphere
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.677
H-Index - 11
ISSN - 2572-9241
DOI - 10.1097/01.hs9.0000562096.38443.d8
Subject(s) - blinatumomab , medicine , fludarabine , busulfan , hematopoietic stem cell transplantation , transplantation , acute lymphocytic leukemia , chemotherapy , salvage therapy , surgery , refractory (planetary science) , oncology , leukemia , lymphoblastic leukemia , cyclophosphamide , physics , astrobiology
Background: Although the complete remission rate of adult acute lymphoblastic leukemia (ALL) are more than 80% with intensive combination chemotherapy, but nearly one half relapse eventually. Patients with relapsed ALL have very poor prognosis with 5‐year survival around 7%. Therefore, optimal use of high dose chemotherapy and allogeneic stem cell transplantation in remission state have been a standard approach. Aims: Conditioning incorporating total body irradiation have been replaced by regimens including busulfan combined with various agents because of its toxicity. The purpose of this retrospective study is to evaluate efficacy and safety of busulfan/fludarabine regimen for allogeneic stem cell transplantation in adult patients with acute lymphoblastic leukemia. Methods: We conducted a retrospective cohort study using data from 112 patients who had allogeneic stem cell transplantation with conditioning regimen of busulfan and fludarabine in 13 centers in Korea between 2007 and 2018. Myeloablative conditioning was defined as regimens with 4 days or more of busulfan (3.2 mg/kg/day) combined with fludarabine. Survival outcomes and incidence of complications of transplantation were evaluated. Results: A total of 112 patients was included in this study. The median age was 45 years (range, 17 to 64 years). More than 95 percent of patients underwent transplantations in complete remission. Myeloablative conditioning was used in 31 (27.7%) among all patients and in 7 (16.3%) among patients of aged 50 or more. With median follow‐up of 22 months (range, 1.2 to 71.2) among survivors, 2‐year overall survival and relapse‐free survival was 57% and 44%, respectively. In multivariate analysis, factors significantly associated with overall survival were the use of reduced‐intensity conditioning (HR 0.43; p < 0.01) and disease status at transplantation. (HR 8.83; P < 0.01 for non‐remission state compared with remission state). There was no difference in PFS according to conditioning intensity. This regimen was well tolerated with nonrelapse mortality of 10% at 6 months and 19% at 2 years post‐transplantation. The incidence of hepatic veno‐occlusive disease was 2 (1.8%) without fatality. The cumulative incidence of relapse, acute GVHD, and chronic GVHD was 50%, 36% and 30%, respectively. Summary/Conclusion: Conditioning using busulfan and fludarabine had an acceptable efficacy and tolerability.