A comparative study of outcomes of idarubicin- and etoposide-intensified conditioning regimens for allogeneic peripheral blood stem cell transplantation in patients with high-risk acute leukemia.
OBJECTIVE
To analyze the results of idarubicin (IDA)- versus etoposide (VP16)-intensified myeloablative conditioning regimen in allogeneic hematopoietic stem cell transplantation (allo-SCT) for high-risk acute leukemia.


METHODS
From January 2005 to June 2008, 48 consecutive patients (male: n=29; median age: 30 years, range 14-51 years) with high-risk acute leukemia underwent allo-SCT following an IDA- or VP16-intensified conditioning regimen. The conditioning regimens were modified BUCY2 (busulfan+cyclophosphamide) consisting of IDA (15 mg/m2 per day, days -12 to -10) or VP16 (25 mg/kg per day, days -3 to -2) and CY/TBI (cyclophosphamide/total body irradiation) intensified with IDA (15 mg/m2 per day, days -6 to -5) or VP16 (25 mg/kg per day, days -3 to -2) for acute myeloid leukemia and acute lymphoblastic leukemia, respectively.


RESULTS
Between the two groups, no significant differences in terms of baseline characteristics, incidence of acute or chronic graft-versus-host disease (GVHD) or transplant-related mortality (TRM) (P=0.50) were observed. However, the IDA group demonstrated higher incidences of mucositis and Aspergillus pneumonia (P<0.01 and P=0.03, respectively). For the IDA and VP16 groups, relapse rates were 28% and 50%, respectively (P=0.13). For the same groups, the 2-year probabilities of leukemia-free survival (LFS) and overall survival (OS) were 72% versus 51% (P=0.04) and 74% versus 53% (P=0.04), respectively.


CONCLUSIONS
This retrospective analysis suggests that conditioning regimens intensified with IDA can achieve better outcomes than conditioning regimens with VP16 in patients preparing to undergo allo-SCT for high-risk acute leukemia.
Li
Qiu-bai
QB
Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong Medical University of Science and Technology, Wuhan 430022, China.
Li
Lei
L
You
Yong
Y
Chen
Zhi-chao
ZC
Xia
Ling-hui
LH
Zou
Ping
P
D000208:Acute Disease; D000971:Antineoplastic Combined Chemotherapy Protocols; D001230:Aspergillus / Q000302:isolation & purification / Q000472:pathogenicity; D002066:Busulfan / Q000008:administration & dosage; D002681:China; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000008:administration & dosage; D003561:Cytarabine / Q000008:administration & dosage; D018572:Disease-Free Survival; D005047:Etoposide / Q000008:administration & dosage*; D005260:Female; D006085:Graft Survival; D006086:Graft vs Host Disease / Q000517:prevention & control; D019337:Hematologic Neoplasms / Q000188:drug therapy / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D006918:Hydroxyurea / Q000008:administration & dosage; D015255:Idarubicin / Q000008:administration & dosage*; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007938:Leukemia / Q000401:mortality / Q000628:therapy*; D015470:Leukemia, Myeloid, Acute / Q000628:therapy; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage; D052016:Mucositis / Q000139:chemically induced; D011014:Pneumonia / Q000139:chemically induced; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000628:therapy; D011292:Premedication; D012189:Retrospective Studies; D012307:Risk Factors; D012673:Semustine / Q000008:administration & dosage; D019172:Transplantation Conditioning / Q000009:adverse effects / Q000379:methods*; D014184:Transplantation, Homologous / Q000009:adverse effects; D016896:Treatment Outcome; D014916:Whole-Body Irradiation
D007166:Immunosuppressive Agents; D003561:Cytarabine; D012673:Semustine; D005047:Etoposide; D003520:Cyclophosphamide; D002066:Busulfan; D008775:Methylprednisolone; D006918:Hydroxyurea; D015255:Idarubicin