title: Outcome of medium-dose VP-16/CY/TBI superior to CY/TBI as a conditioning regimen for allogeneic stem cell transplantation in adult patients with acute lymphoblastic leukemia.
abstract: The choice of conditioning regimen before allogeneic stem cell transplantation (SCT) in patients with acute lymphoblastic leukemia (ALL) is important. We retrospectively compared outcomes of medium-dose VP-16/cyclophosphamide/total body irradiation (VP/CY/TBI) regimen and CY/TBI. Five hundred and twenty-nine patients (VP/CY/TBI: n = 35, CY/TBI: n = 494) who met all of the following criteria were compared: first time for SCT, aged 15-59 years; first or second complete remission at SCT; bone marrow or peripheral blood as stem cell source; and HLA phenotypically matched donor. Median age of the patients was 34 years, and patients who received VP/CY/TBI were younger (28 vs. 34 years, P = 0.02). Cumulative incidences of relapse and non-relapse mortality (NRM) were higher for patients who received CY/TBI (P = 0.01 for relapse, P < 0.01 for NRM). After a median follow-up period of 36.9 months, 5-year overall survival (OS) rates were 82.2% in the VP/CY/TBI group and 55.2% in the CY/TBI group. OS, and disease-free survival (DFS) in the VP/CY/TBI group were shown to be significantly better by multivariate analysis [hazard ratio: 0.21 (95% confidence interval: 0.06-0.49) for DFS, hazard ratio: 0.25 (95% confidence interval: 0.08-0.59) for OS]. VP/CY/TBI was associated with a lower relapse rate and no increase in NRM, resulting in better survival than that in CY/TBI for adult ALL patients.
authors: Stem Cell Transplantation Center, Hokkaido University Hospital, Sapporo, Japan. shigemap@mac.com
authors: Akio
authors: A
authors: Shigematsu
authors: Junji
authors: J
authors: Tanaka
authors: Ritsuro
authors: R
authors: Suzuki
authors: Yoshiko
authors: Y
authors: Atsuta
authors: Takakazu
authors: T
authors: Kawase
authors: Yoichi M
authors: YM
authors: Ito
authors: Takuya
authors: T
authors: Yamashita
authors: Takahiro
authors: T
authors: Fukuda
authors: Keiki
authors: K
authors: Kumano
authors: Koji
authors: K
authors: Iwato
authors: Fumiaki
authors: F
authors: Yoshiba
authors: Heiwa
authors: H
authors: Kanamori
authors: Naoki
authors: N
authors: Kobayashi
authors: Takashi
authors: T
authors: Fukuhara
authors: Yasuo
authors: Y
authors: Morishima
authors: Masahiro
authors: M
authors: Imamura
mesh_terms: D000293:Adolescent; D000328:Adult; D003520:Cyclophosphamide / Q000008:administration & dosage*; D005047:Etoposide / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D033581:Stem Cell Transplantation / Q000401:mortality; D015996:Survival Rate; D019172:Transplantation Conditioning / Q000401:mortality; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014916:Whole-Body Irradiation; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents; D005047:Etoposide; D003520:Cyclophosphamide