title: Comparable long-term outcomes after reduced-intensity conditioning versus myeloablative conditioning allogeneic stem cell transplantation for adult high-risk acute lymphoblastic leukemia in complete remission.
abstract: The role of reduced-intensity conditioning (RIC) in adult acute lymphoblastic leukemia (ALL) remains unclear because of the small sample size, short follow-up duration, various regimens for conditioning and graft-versus-host disease (GVHD) prophylaxis, and the heterogeneity of selection criteria for transplantation. We compared long-term outcomes of 60 consecutive RIC transplants (fludarabine plus melphalan) with 120 myeloablative conditioning (MAC) transplants (total body irradiation plus cyclophosphamide) for adult high-risk ALL in first or second complete remission. All transplants received a uniform strategy of pretransplant chemotherapy and GVHD prophylaxis. Compared to MAC transplants, RIC transplants had older age (46 years vs. 33 years, P < 0.001) and higher proportions of transplantation using peripheral blood (93.3% vs. 13.3%; P < 0.001) but otherwise showed similar characteristics. After a median follow-up of 67 months, RIC transplants showed comparable nonrelapse mortality (21.2% vs. 24.3%) and disease-free survival (50.8% vs. 54.9%) to MAC transplants, although relapse risk was higher (34.2% vs. 26.4%; HR, 2.07; P = 0.019) in multivariate analysis. Other independent factors associated with better outcomes were the presence of chronic GVHD and transplantation in first complete remission. Interestingly, the negative impact of RIC on relapse risk was seen only for Philadelphia-positive ALL transplants (32.7% vs. 19.6%; HR, 3.46; P = 0.020), while no difference was found between RIC and MAC for Philadelphia-negative ALL transplants (35.0% vs. 32.1%; HR, 1.39; P = 0.429). RIC can be considered as a reasonable choice for providing a sufficient long-term graft-versus-leukemia effect for adult high-risk ALL patients ineligible for MAC.
authors.affiliation: Department of Hematology, Catholic BMT Center, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea (South Korea).
authors.forename: Ki-Seong
authors.initials: KS
authors.lastname: Eom
authors.forename: Seung-Hwan
authors.initials: SH
authors.lastname: Shin
authors.forename: Jae-Ho
authors.initials: JH
authors.lastname: Yoon
authors.forename: Seung-Ah
authors.initials: SA
authors.lastname: Yahng
authors.forename: Sung-Eun
authors.initials: SE
authors.lastname: Lee
authors.forename: Byung-Sik
authors.initials: BS
authors.lastname: Cho
authors.forename: Yoo-Jin
authors.initials: YJ
authors.lastname: Kim
authors.forename: Hee-Je
authors.initials: HJ
authors.lastname: Kim
authors.forename: Chang-Ki
authors.initials: CK
authors.lastname: Min
authors.forename: Dong-Wook
authors.initials: DW
authors.lastname: Kim
authors.forename: Jong-Wook
authors.initials: JW
authors.lastname: Lee
authors.forename: Woo-Sung
authors.initials: WS
authors.lastname: Min
authors.forename: Chong-Won
authors.initials: CW
authors.lastname: Park
authors.forename: Seok
authors.initials: S
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D000328:Adult; D003520:Cyclophosphamide / Q000008:administration & dosage; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000401:mortality / Q000517:prevention & control / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D019653:Myeloablative Agonists / Q000008:administration & dosage; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000401:mortality* / Q000628:therapy*; D012074:Remission Induction; D012189:Retrospective Studies; D012307:Risk Factors; D033581:Stem Cell Transplantation; D015996:Survival Rate; D019172:Transplantation Conditioning / Q000379:methods*; D014184:Transplantation, Homologous; D014916:Whole-Body Irradiation / Q000379:methods
chemical_list: D019653:Myeloablative Agonists; D003520:Cyclophosphamide