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Conditioning Regimens After HCT Compared in ALL

Biol Blood Marrow Transplant; ePub 2017 Nov 29; Kebriaei, et al

Use of busulfan-containing conditioning (BU) or total body irradiation (TBI) resulted in similar overall and disease-free survival after hematopoietic cell transplantation (HCT) in people with acute lymphoblastic leukemia (ALL), according to a retrospective study involving >1,100 individuals. Participants with ALL in first or second complete remission (CR) underwent HLA-compatible sibling, related, or unrelated donor HCT. They received either TBI or BU-based conditioning.

BU patients were older; had better performance status; took longer to achieve CR1 and receive HCT; were treated more recently; and were more likely to receive peripheral blood grafts, anti-thymocyte globulin, and/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:

  • BU treatment-related mortality rate was 19%, vs 25% for TBI.
  • Relapse rates were 37% and 28%, respectively.
  • Disease-free survival rates were 45% and 48%, respectively.
  • Overall survival rates were 57% and 53%, respectively.

BU patients were 46% more likely to relapse than those receiving TBI.

Citation:

Kebriaei P, Anasetti C, Zhang M, et al. Intravenous busulfan compared to total body irradiation pre-transplant conditioning for adults with acute lymphoblastic leukemia. [Published online ahead of print November 29, 2017]. Biol Blood Marrow Transplant. doi:10.1016/j.bbmt.2017.11.025.

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