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.
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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Ibrutinib and infection risk, Ghez D et al. Blood. 2018 Feb 1. doi: 10.1182/blood-2017-11-818286.
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This Appears to Predispose Children to ALL , J Clin Oncol; ePub 2018 Jan 4; Qian, Cao, et al
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Encourage This Behavior in Childhood ALL Survivors, Cancer; ePub 2017 Dec 4; Howell, Wilson, et al
Conditioning Regimens After HCT Compared in ALL, Biol Blood Marrow Transplant; ePub 2017 Nov 29; Kebriaei, et al
QoL in Children During ALL Treatment Evaluated, Cancer; ePub 2017 Nov 7; Zheng, Lu, Schore, et al