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

Partow Kebriaei; Claudio Anasetti; Mei-Jie Zhang; Hai-Lin Wang; Ibrahim Aldoss; Marcos de Lima; H. Jean Khoury; Brenda M Sandmaier; Mary M Horowitz; Andrew Artz; Nelli Bejanyan; Stefan Ciurea; Hillard M Lazarus; Robert Peter Gale; Mark Litzow; Christopher Bredeson; Matthew D Seftel; Michael A Pulsipher; Jaap-Jan Boelens; Joseph Alvarnas; Richard Champlin; Stephen Forman; Vinod Pullarkat; Daniel Weisdorf; David I Marks; William Hogan; Minoo Battiwalla; Edward Copelan; Gerhard Hildebrandt; Sid Ganguly; Navneet Majhail; Ann Woolfrey; Ian Nivison-Smith; Mark Hertzberg; Miguel Angel Diaz; Ann Jakubowski; Celalettin Ustun; Agnes Yong; Cesar Freytes; Zachariah DeFilipp; Yoshi Inamoto; Jean-Yves Cahn; Bipin Savani; Jean Yared; Ashish Bajel; Ulrike Bacher; Geoffrey Uy; David Rizzieri; Matthew Wieduwilt; Kirk Schultz; Michael Grunwald; Rammurti Kamble; Muna Qayed; Jonathan Brammer; Karen Ballen; Nandita Khera; Harry Schouten; Marc Bierings; Christopher Kanakry; William Allen Wood; Ayman Saad; Lynn Savoie; Betty Ky Hamilton; Mahmoud Aljurf; Ravi Vij; Attaphol Pawarode; Richard Olsson; B. Mona Wirk; Amer Beitinjaneh; Sachiko Seo; Jan Cerny; Gorgun Akpek; Maxim Norkin; Taiga Nishihori; Aleksandr Lazaryan; Mitchell Sabloff; Acute Leukemia Committee of the CIBMTR

doi:10.1016/j.bbmt.2017.11.025

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

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

Partow Kebriaei, Claudio Anasetti, Mei-Jie Zhang, Hai-Lin Wang, Ibrahim Aldoss, Marcos de Lima, H. Jean Khoury, Brenda M Sandmaier, Mary M Horowitz, Andrew Artz, …

Biology of blood and marrow transplantation, Vol.24(4), pp.726-733

2018-04

DOI: https://doi.org/10.1016/j.bbmt.2017.11.025

PMID: 29197676

Abstract

Total body irradiation

Allogeneic transplant

Busulfan

Acute lymphoblastic leukemia

•TBI and Bu-based preparative regimens confer equivalent survival post-HCT in adult ALL.•More relapse, trend for less cGVHD for Bu-based regimens in multivariate analysis.•TBI-based regimens confer good disease control, but trend for more TRM. 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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Collaboration types: Domestic collaboration; International collaboration
Citation topics: 1 Clinical & Life Sciences; 1.103 Blood Disorders; 1.103.380 GvHD
Web Of Science research areas: Hematology; Immunology; Transplantation
ESI research areas: Immunology

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Title: Intravenous Busulfan Compared with Total Body Irradiation Pretransplant Conditioning for Adults with Acute Lymphoblastic Leukemia
Creators: Partow Kebriaei - Department of Stem Cell Transplantation, Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas
Claudio Anasetti - Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer Center Research Institute, Tampa, Florida
Mei-Jie Zhang - Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, Wisconsin
Hai-Lin Wang - CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
Ibrahim Aldoss - Department of Hematology & Hematopoietic Cell Transplantation, City of Hope Medical Center, Duarte, California
Marcos de Lima - Department of Medicine, Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, Ohio
H. Jean Khoury - Division of Hematology and Oncology, Emory University Hospital, Atlanta, Georgia
Brenda M Sandmaier - Division of Medical Oncology, University of Washington and Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
Mary M Horowitz - CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
Andrew Artz - Section of Hematology/Oncology, University of Chicago School of Medicine, Chicago, Illinois
Nelli Bejanyan - Division of Hematology, Oncology and Transplantation, University of Minnesota Medical Center, Minneapolis, Minnesota
Stefan Ciurea - Department of Stem Cell Transplantation, Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas
Hillard M Lazarus - Department of Medicine, Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, Ohio
Robert Peter Gale - Hematology Research Centre, Division of Experimental Medicine, Department of Medicine, Imperial College London, London, United Kingdom
Mark Litzow - Division of Hematology, Department of Internal Medicine, Mayo Clinic Rochester, Rochester, Minnesota
Christopher Bredeson - Ottawa Hospital Blood and Marrow Transplant Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
Matthew D Seftel - Department of Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
Michael A Pulsipher - Division of Hematology, Oncology, and Blood and Marrow Transplantation, Children's Hospital Los Angeles, USC Keck School of Medicine, Los Angeles, California
Jaap-Jan Boelens - University Medical Center Utrecht, Utrecht, the Netherlands
Joseph Alvarnas - Department of Hematology & Hematopoietic Cell Transplantation, City of Hope Medical Center, Duarte, California
Richard Champlin - Department of Stem Cell Transplantation, Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas
Stephen Forman - Department of Hematology & Hematopoietic Cell Transplantation, City of Hope Medical Center, Duarte, California
Vinod Pullarkat - Department of Hematology & Hematopoietic Cell Transplantation, City of Hope Medical Center, Duarte, California
Daniel Weisdorf - Division of Hematology, Oncology and Transplantation, University of Minnesota Medical Center, Minneapolis, Minnesota
David I Marks - Adult Bone Marrow Transplant, University Hospitals Bristol NHS Trust, Bristol, United Kingdom
William Hogan
Minoo Battiwalla
Edward Copelan
Gerhard Hildebrandt
Sid Ganguly
Navneet Majhail
Ann Woolfrey
Ian Nivison-Smith
Mark Hertzberg
Miguel Angel Diaz
Ann Jakubowski
Celalettin Ustun
Agnes Yong
Cesar Freytes
Zachariah DeFilipp
Yoshi Inamoto
Jean-Yves Cahn
Bipin Savani
Jean Yared
Ashish Bajel
Ulrike Bacher
Geoffrey Uy
David Rizzieri
Matthew Wieduwilt
Kirk Schultz
Michael Grunwald
Rammurti Kamble
Muna Qayed
Jonathan Brammer
Karen Ballen
Nandita Khera
Harry Schouten
Marc Bierings
Christopher Kanakry
William Allen Wood
Ayman Saad
Lynn Savoie
Betty Ky Hamilton
Mahmoud Aljurf
Ravi Vij
Attaphol Pawarode
Richard Olsson
B. Mona Wirk
Amer Beitinjaneh
Sachiko Seo
Jan Cerny
Gorgun Akpek
Maxim Norkin
Taiga Nishihori
Aleksandr Lazaryan
Mitchell Sabloff
Acute Leukemia Committee of the CIBMTR
Publication Details: Biology of blood and marrow transplantation, Vol.24(4), pp.726-733
Publisher: Elsevier Inc
Academic Unit: Miller School of Medicine; UMMG Dept of Medicine - Hematology/Oncology
Language: English
Resource Type: Journal article
PMID: 29197676
Record Identifier: 991031600354402976