title: Fludarabine, busulfan, antithymocyte globulin, and total body irradiation for pretransplantation conditioning in acute lymphoblastic leukemia: excellent outcomes in all but older patients with comorbidities.
abstract: Hematopoietic stem cell transplantation (SCT) is routinely offered to suitable candidates with high-risk or advanced acute lymphoblastic leukemia (ALL). In this report, we update our experience with SCT in patients with ALL with a novel conditioning regimen. A total of 44 patients with high-risk or advanced (greater than first complete remission) ALL in remission underwent SCT after myeloablative conditioning with fludarabine + busulfan + total body irradiation. The median follow-up of surviving patients was 4.3 years (range, 1.0-9.0 years). The cohort consists of 32 patients with high-risk disease (median age, 40 years; range, 19-64 years) and 12 patients with advanced disease (median age, 25 years; range, 19-65 years) who underwent SCT: 25 with a related donor (21 fully matched) and 19 with an unrelated donor (16 fully matched). The cumulative incidence of grade II-IV acute graft-versus-host disease (GVHD) was 53.2%, and that of grade III-IV acute GVHD was 20.6%. The incidence of chronic GVHD was 55%. The 100-day nonrelapse mortality was 13.6%. Five-year progression-free survival was 56.7%, and 5-year overall survival was 66.0%. Nine patients (20%) died in remission, 6 (14%) died after relapse, and 2 survived after a second SCT for relapsed disease. Outcomes were inferior in older patients with comorbidities compared with other patients.
authors: Alberta Blood and Marrow Transplant Program, Tom Baker Cancer Center, Calgary, Alberta, Canada. andrew.daly@albertahealthservices.ca
authors: Andrew
authors: A
authors: Daly
authors: Mary L
authors: ML
authors: Savoie
authors: Michelle
authors: M
authors: Geddes
authors: Ahsan
authors: A
authors: Chaudhry
authors: Douglas
authors: D
authors: Stewart
authors: Peter
authors: P
authors: Duggan
authors: Nizar
authors: N
authors: Bahlis
authors: Jan
authors: J
authors: Storek
authors: Chris
authors: C
authors: Brown
authors: Mona
authors: M
authors: Shafey
authors: A Robert
authors: AR
authors: Turner
authors: James
authors: J
authors: Russell
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000961:Antilymphocyte Serum / Q000008:administration & dosage*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D002066:Busulfan / Q000008:administration & dosage; D015331:Cohort Studies; D015897:Comorbidity; D018572:Disease-Free Survival; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy* / Q000601:surgery*; D016019:Survival Analysis; D019172:Transplantation Conditioning / Q000379:methods*; D016896:Treatment Outcome; D014740:Vidarabine / Q000008:administration & dosage / Q000031:analogs & derivatives; D014916:Whole-Body Irradiation / Q000379:methods*; D055815:Young Adult
chemical_list: D000961:Antilymphocyte Serum; D014740:Vidarabine; D002066:Busulfan; C024352:fludarabine