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Intravenous Busulfan Compared with Total Body Irradiation Pretransplant Conditioning for Adults with Acute Lymphoblastic Leukemia.

Publication ,  Journal Article
Kebriaei, P; Anasetti, C; Zhang, M-J; Wang, H-L; Aldoss, I; de Lima, M; Khoury, HJ; Sandmaier, BM; Horowitz, MM; Artz, A; Bejanyan, N ...
Published in: Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation
April 2018

Total body irradiation (TBI) has been included in standard conditioning for acute lymphoblastic leukemia (ALL) before hematopoietic cell transplantation (HCT). Non-TBI regimens have incorporated busulfan (Bu) to decrease toxicity. This retrospective study analyzed TBI and Bu on outcomes of ALL patients 18-60 years old, in first or second complete remission (CR), undergoing HLA-compatible sibling, related, or unrelated donor HCT, who reported to the Center for International Blood and Marrow Transplant Research from 2005 to 2014. TBI plus etoposide (25%) or cyclophosphamide (75%) was used in 819 patients, and intravenous Bu plus fludarabine (41%), clofarabine (30%), cyclophosphamide (15%), or melphalan (13%) was used in 299 patients. Bu-containing regimens were analyzed together, since no significant differences for patient outcomes were noted between them. Bu patients were older, with better performance status; took longer to achieve first CR and receive HCT; were treated more recently; and were more likely to receive peripheral blood grafts, antithymocyte globulin, 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 treatment-related mortality Bu 19% versus TBI 25% (P = .04); relapse Bu 37% versus TBI 28% (P = .007); disease-free survival (DFS) Bu 45% versus TBI 48% (P = .35); and overall survival (OS) Bu 57% versus TBI 53% (P = .35). In multivariate analysis, Bu patients had higher risk of relapse (relative risk, 1.46; 95% confidence interval, 1.15 to 1.85; P = .002) compared with TBI patients. Despite the higher relapse, Bu-containing conditioning led to similar OS and DFS following HCT for ALL.

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Published In

Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation

DOI

EISSN

1523-6536

ISSN

1083-8791

Publication Date

April 2018

Volume

24

Issue

4

Start / End Page

726 / 733

Related Subject Headings

  • Whole-Body Irradiation
  • Transplantation Conditioning
  • Survival Rate
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma
  • Middle Aged
  • Male
  • Immunology
  • Humans
  • Hematopoietic Stem Cell Transplantation
  • Follow-Up Studies
 

Citation

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Kebriaei, P., Anasetti, C., Zhang, M.-J., Wang, H.-L., Aldoss, I., de Lima, M., … Acute Leukemia Committee of the CIBMTR, . (2018). Intravenous Busulfan Compared with Total Body Irradiation Pretransplant Conditioning for Adults with Acute Lymphoblastic Leukemia. Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation, 24(4), 726–733. https://doi.org/10.1016/j.bbmt.2017.11.025
Kebriaei, Partow, Claudio Anasetti, Mei-Jie Zhang, Hai-Lin Wang, Ibrahim Aldoss, Marcos de Lima, H Jean Khoury, et al. “Intravenous Busulfan Compared with Total Body Irradiation Pretransplant Conditioning for Adults with Acute Lymphoblastic Leukemia.Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation 24, no. 4 (April 2018): 726–33. https://doi.org/10.1016/j.bbmt.2017.11.025.
Kebriaei P, Anasetti C, Zhang M-J, Wang H-L, Aldoss I, de Lima M, et al. Intravenous Busulfan Compared with Total Body Irradiation Pretransplant Conditioning for Adults with Acute Lymphoblastic Leukemia. Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation. 2018 Apr;24(4):726–33.
Kebriaei, Partow, et al. “Intravenous Busulfan Compared with Total Body Irradiation Pretransplant Conditioning for Adults with Acute Lymphoblastic Leukemia.Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation, vol. 24, no. 4, Apr. 2018, pp. 726–33. Epmc, doi:10.1016/j.bbmt.2017.11.025.
Kebriaei P, Anasetti C, Zhang M-J, Wang H-L, Aldoss I, de Lima M, Khoury HJ, Sandmaier BM, Horowitz MM, Artz A, Bejanyan N, Ciurea S, Lazarus HM, Gale RP, Litzow M, Bredeson C, Seftel MD, Pulsipher MA, Boelens J-J, Alvarnas J, Champlin R, Forman S, Pullarkat V, Weisdorf D, Marks DI, Acute Leukemia Committee of the CIBMTR. Intravenous Busulfan Compared with Total Body Irradiation Pretransplant Conditioning for Adults with Acute Lymphoblastic Leukemia. Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation. 2018 Apr;24(4):726–733.
Journal cover image

Published In

Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation

DOI

EISSN

1523-6536

ISSN

1083-8791

Publication Date

April 2018

Volume

24

Issue

4

Start / End Page

726 / 733

Related Subject Headings

  • Whole-Body Irradiation
  • Transplantation Conditioning
  • Survival Rate
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma
  • Middle Aged
  • Male
  • Immunology
  • Humans
  • Hematopoietic Stem Cell Transplantation
  • Follow-Up Studies