Journal
BIOLOGY OF BLOOD AND MARROW TRANSPLANTATION
Volume 19, Issue 2, Pages 255-259Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.bbmt.2012.09.019
Keywords
TBI dose; Leukemia recurrence
Categories
Funding
- Public Health Service Grant/Cooperative Agreement [U24-CA76518]
- National Cancer Institute, National Heart, Lung and Blood Institute
- National Institute of Allergy and Infectious Diseases [5U01HL069294]
- National Heart, Lung and Blood Institute and National Cancer Institute
- Health Resources and Services Administration [HHSH234200637015C]
- Office of Naval Research [N00014-06-1-0704, N00014-08-1-0058]
- Allos
- Amgen
- Angioblast
- Ariad
- Be the Match Foundation
- Blue Cross and Blue Shield Association
- Buchanan Family Foundation
- Caridian BCT
- Celgene
- Celgene, CellGenix
- Children's Leukemia Research Association
- Fresenius-Biotech North America
- Gamida Cell Teva Joint Venture
- Genentech
- Genzyme
- GlaxoSmithKline
- HistoGenetics
- Kiadis Pharma
- Medical College of Wisconsin
- Merck Co
- Millennium: Takeda Oncology
- Milliman USA
- Miltenyi Biotec
- National Marrow Donor Program
- Optum Healthcare Solutions
- Osiris Therapeutics
- Otsuka America Pharmaceutical
- RemedyMD
- Sanofi, Seattle Genetics
- Sigma-Tau Pharmaceuticals
- Soligenix
- StemCyte
- Stemsoft Software
- Swedish Orphan Biovitrum
- Tarix Pharmaceuticals
- Teva Neuroscience
- Therakos
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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. (C) 2013 American Society for Blood and Marrow Transplantation.
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