title: Excellent outcome of allogeneic hematopoietic stem cell transplantation using a conditioning regimen with medium-dose VP-16, cyclophosphamide and total-body irradiation for adult patients with acute lymphoblastic leukemia.
abstract: We retrospectively evaluated the outcomes of 37 adult patients with acute lymphoblastic leukemia (ALL) undergoing allogeneic hematopoietic stem cell transplantation (allo-SCT) conditioned with medium-dose VP-16 (VP, 30 mg/kg), cyclophosphamide (CY, 120 mg/kg), and fractionated total-body irradiation (TBI, 12 Gy) (medium-dose VP/CY/TBI). The median age of the patients was 26 years. Thirteen patients underwent transplantation from HLA-matched related donors (MRD), 18 patients underwent transplantation from HLA-matched unrelated donors (MUD), and 6 patients underwent transplantation from HLA-mismatched donors (MMD). Thirty-two patients received bone marrow and 4 patients received peripheral blood stem cells. Ten patients were Philadelphia chromosome-positive (Ph(+)) and 35 patients were in complete remission (CR) at transplantation. All of the patients achieved engraftment, and grade 3 organ toxicity before engraftment occurred in 27 patients. Grade II-III acute graft-versus-host disease (GVHD) and chronic GVHD (cGVHD) occurred in 15 and 18 patients, respectively. No patient developed grade IV acute GVHD (aGVHD) or died of GVHD. At median follow-up of 35.1 months, 32 patients were alive and all Ph(+) patients were alive. Three patients died of relapse and 2 died of transplant-related mortality (TRM). The actuarial 3-year overall survival (OS) rate, relapse rate, and TRM rate were 89.2%, 8.1%, and 5.4%, respectively. Non-CR at transplantation, MRD, and no aGVHD were significant adverse prognostic factors for survival. Medium-dose VP/CY/TBI for adult ALL patients was associated with lower relapse rate and no increase in toxicity, resulting in better survival.
authors.affiliation: Department of Hematology and Oncology, Hokkaido University Graduate School of Medicine, Sapporo, Japan. shigemap@r9.dion.ne.jp
authors.forename: Akio
authors.initials: A
authors.lastname: Shigematsu
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kondo
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yamamoto
authors.forename: Junichi
authors.initials: J
authors.lastname: Sugita
authors.forename: Masahiro
authors.initials: M
authors.lastname: Onozawa
authors.forename: Kaoru
authors.initials: K
authors.lastname: Kahata
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Endo
authors.forename: Soichi
authors.initials: S
authors.lastname: Shiratori
authors.forename: Shuichi
authors.initials: S
authors.lastname: Ota
authors.forename: Masato
authors.initials: M
authors.lastname: Obara
authors.forename: Kentaro
authors.initials: K
authors.lastname: Wakasa
authors.forename: Mutsumi
authors.initials: M
authors.lastname: Takahata
authors.forename: Yukari
authors.initials: Y
authors.lastname: Takeda
authors.forename: Junji
authors.initials: J
authors.lastname: Tanaka
authors.forename: Satoshi
authors.initials: S
authors.lastname: Hashino
authors.forename: Mitsufumi
authors.initials: M
authors.lastname: Nishio
authors.forename: Takao
authors.initials: T
authors.lastname: Koike
authors.forename: Masahiro
authors.initials: M
authors.lastname: Asaka
authors.forename: Masahiro
authors.initials: M
authors.lastname: Imamura
mesh_terms: D000293:Adolescent; D000328:Adult; D003520:Cyclophosphamide / Q000008:administration & dosage* / Q000633:toxicity; D005047:Etoposide / Q000008:administration & dosage* / Q000633:toxicity; D006086:Graft vs Host Disease; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006801:Humans; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications / Q000532:radiotherapy / Q000628:therapy*; D011379:Prognosis; D012074:Remission Induction; D012189:Retrospective Studies; D016019:Survival Analysis; D019172:Transplantation Conditioning / Q000009:adverse effects / Q000379:methods*; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014916:Whole-Body Irradiation
chemical_list: D005047:Etoposide; D003520:Cyclophosphamide