Effect of conditioning regimen on the outcome of bone marrow transplantation from an unrelated donor.
Little information is available regarding the effect of the conditioning regimen on the outcome of bone marrow transplantation (BMT) from an unrelated donor. Therefore, we retrospectively compared the outcome after a cyclophosphamide/total body irradiation (Cy-TBI) regimen, an intensified Cy-TBI regimen (Cy-TBI+), a busulfan and cyclophosphamide (Bu-Cy) regimen, and a Bu-Cy regimen with total lymphoid irradiation (Bu-Cy-TLI). Clinical data of 1875 adult patients who underwent unmanipulated unrelated BMT for leukemia or myelodysplastic syndrome by using 1 of the 4 regimens between 1993 and 2002 were extracted from the database of the Japan Marrow Donor Program. The effect of the conditioning regimen was adjusted for other independent significant factors by multivariate analyses. The Cy-TBI regimen was significantly better than the Bu-Cy regimen with regard to the incidence of engraftment failure (odds ratio, 2.49; P = .046) and overall survival (relative risk [RR], 1.31; P = .050). The Bu-Cy-TLI regimen decreased relapse (RR, 0.13; P = .039) but increased nonrelapse mortality (RR, 1.89; P = .0061). The Cy-TBI+ regimen resulted in increased nonrelapse mortality (RR, 1.48; P = .0003) and inferior survival (RR, 1.45; P < .0001). The results of this retrospective study suggested that the Cy-TBI regimen was superior to other regimens in unrelated BMT.
Kanda
Yoshinobu
Y
Department of Cell Therapy & Transplantation Medicine, University of Tokyo, Hongo, Tokyo, Japan. ycanda-tky@umin.ac.jp
Sakamaki
Hisashi
H
Sao
Hiroshi
H
Okamoto
Shinichiro
S
Kodera
Yoshihisa
Y
Tanosaki
Ryuji
R
Kasai
Masaharu
M
Hiraoka
Akira
A
Takahashi
Satoshi
S
Miyawaki
Shuichi
S
Kawase
Takakazu
T
Morishima
Yasuo
Y
Kato
Shunichi
S
D000293:Adolescent; D000328:Adult; D016026:Bone Marrow Transplantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D002066:Busulfan / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000627:therapeutic use; D016208:Databases, Factual; D005260:Female; D006085:Graft Survival; D006801:Humans; D007938:Leukemia / Q000401:mortality / Q000628:therapy; D015182:Lymphatic Irradiation; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009190:Myelodysplastic Syndromes / Q000401:mortality / Q000628:therapy; D012189:Retrospective Studies; D016019:Survival Analysis; D014019:Tissue Donors; D019172:Transplantation Conditioning / Q000379:methods* / Q000401:mortality / Q000592:standards; D016896:Treatment Outcome; D014916:Whole-Body Irradiation
D003520:Cyclophosphamide; D002066:Busulfan