title: Comparison of outcomes of allogeneic transplantation for chronic myeloid leukemia with cyclophosphamide in combination with intravenous busulfan, oral busulfan, or total body irradiation.
abstract: Cyclophosphamide (Cy) in combination with busulfan (Bu) or total body irradiation (TBI) is the most commonly used myeloablative conditioning regimen in patients with chronic myeloid leukemia (CML). We used data from the Center for International Bone Marrow Transplantation Research to compare outcomes in adults who underwent hematopoietic cell transplantation for CML in first chronic phase after myeloablative conditioning with Cy in combination with TBI, oral Bu, or intravenous (i.v.) Bu. Four hundred thirty-eight adults received human leukocyte antigen (HLA)-matched sibling grafts and 235 received well-matched grafts from unrelated donors (URD) from 2000 through 2006. Important differences existed between the groups in distribution of donor relation, exposure to tyrosine kinase inhibitors, and year of transplantation. In multivariate analysis, relapse occurred less frequently among patients receiving i.v. Bu compared with TBI (relative risk [RR], .36; P = .022) or oral Bu (RR, .39; P = .028), but nonrelapse mortality and survival were similar. A significant interaction was detected between donor relation and the main effect in leukemia-free survival (LFS). Among recipients of HLA-identical sibling grafts, but not URD grafts, LFS was better in patients receiving i.v. Bu (RR, .53; P = .025) or oral Bu (RR, .64; P = .017) compared with TBI. In CML in first chronic phase, Cy in combination with i.v. Bu was associated with less relapse than TBI or oral Bu. LFS was better after i.v. or oral Bu compared with TBI.
authors.affiliation: Levine Cancer Institute, Carolinas Healthcare System, Charlotte, North Carolina. Electronic address: Heather.T.Johnson@carolinashealthcare.org.
authors.forename: Edward A
authors.initials: EA
authors.lastname: Copelan
authors.affiliation: Levine Cancer Institute, Carolinas Healthcare System, Charlotte, North Carolina.
authors.forename: Belinda R
authors.initials: BR
authors.lastname: Avalos
authors.affiliation: Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, Wisconsin; Department of Medicine, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Kwang Woo
authors.initials: KW
authors.lastname: Ahn
authors.affiliation: Department of Medicine, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Xiaochun
authors.initials: X
authors.lastname: Zhu
authors.affiliation: Division of Experimental Medicine, Department of Medicine, Hematology Research Centre, Imperial College of London, London, United Kingdom.
authors.forename: Robert Peter
authors.initials: RP
authors.lastname: Gale
authors.affiliation: Levine Cancer Institute, Carolinas Healthcare System, Charlotte, North Carolina.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Grunwald
authors.affiliation: Department of Medicine, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Mehdi
authors.initials: M
authors.lastname: Hamadani
authors.affiliation: Department of Hematology and Oncology, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Betty K
authors.initials: BK
authors.lastname: Hamilton
authors.affiliation: Department of Hematology/Oncology, All Children's Hospital, St Petersburg, Florida.
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Hale
authors.affiliation: University Hospitals Bristol NHS Trust, Bristol, United Kingdom.
authors.forename: David I
authors.initials: DI
authors.lastname: Marks
authors.affiliation: Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia.
authors.forename: Edmund K
authors.initials: EK
authors.lastname: Waller
authors.affiliation: Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Bipin N
authors.initials: BN
authors.lastname: Savani
authors.affiliation: Division of Hematology/Oncology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Luciano J
authors.initials: LJ
authors.lastname: Costa
authors.affiliation: Division of Hematology Oncology, UMass Memorial Medical Center, Worcester, Massachusetts.
authors.forename: Muthalagu
authors.initials: M
authors.lastname: Ramanathan
authors.affiliation: Department of Hematology, University Hospital, Grenoble, France.
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Cahn
authors.affiliation: Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia.
authors.forename: H Jean
authors.initials: HJ
authors.lastname: Khoury
authors.affiliation: Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota Medical Center, Minneapolis, Minnesota.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Weisdorf
authors.affiliation: Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Inamoto
authors.affiliation: Division of Hematology and Oncology, Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, Texas.
authors.forename: Rammurti T
authors.initials: RT
authors.lastname: Kamble
authors.affiliation: Divison of Hematology, Academische Ziekenhuis Maastricht, Maastricht, Netherlands.
authors.forename: Harry C
authors.initials: HC
authors.lastname: Schouten
authors.affiliation: Department of Internal Medicine, Stony Brook University Medical Center, Stony Brook, New York.
authors.forename: Baldeep
authors.initials: B
authors.lastname: Wirk
authors.affiliation: Department of Hematology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Mark R
authors.initials: MR
authors.lastname: Litzow
authors.affiliation: Department of Oncology, King Faisal Specialist Hospital Center & Research, Riyadh, Saudi Arabia.
authors.forename: Mahmoud D
authors.initials: MD
authors.lastname: Aljurf
authors.affiliation: Department of Medical Oncology, Weill Cornell Medical College, New York, New York.
authors.forename: Koen W
authors.initials: KW
authors.lastname: van Besien
authors.affiliation: Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota Medical Center, Minneapolis, Minnesota.
authors.forename: Celalettin
authors.initials: C
authors.lastname: Ustun
authors.affiliation: Department of Hematology and Oncology, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Bolwell
authors.affiliation: The Ottawa Hospital Blood & Marrow Transplant Program and the Ottawa Hospital Research Institute, Ottawa, ON, Canada.
authors.forename: Christopher N
authors.initials: CN
authors.lastname: Bredeson
authors.affiliation: Levine Cancer Institute, Carolinas Healthcare System, Charlotte, North Carolina.
authors.forename: Omotayo
authors.initials: O
authors.lastname: Fasan
authors.affiliation: Levine Cancer Institute, Carolinas Healthcare System, Charlotte, North Carolina.
authors.forename: Nilanjan
authors.initials: N
authors.lastname: Ghosh
authors.affiliation: Department of Medicine, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Mary M
authors.initials: MM
authors.lastname: Horowitz
authors.affiliation: Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota Medical Center, Minneapolis, Minnesota.
authors.forename: Mukta
authors.initials: M
authors.lastname: Arora
authors.affiliation: Department of Clinical Haematology and Bone Marrow Transplantation, Royal Melbourne Hospital, Parkville, Victoria, Australia.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Szer
authors.affiliation: Division of Hematology/Oncology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Alison W
authors.initials: AW
authors.lastname: Loren
authors.affiliation: Center of Hematologic Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
authors.forename: Edwin P
authors.initials: EP
authors.lastname: Alyea
authors.affiliation: Division of Cancer Medicine, Department of Leukemia, The University of Texas M.D. Anderson Cancer Center, Houston, Texas.
authors.forename: Jorge
authors.initials: J
authors.lastname: Cortes
authors.affiliation: Center for Hematologic Malignancies, Oregon Health and Science University, Portland, Oregon.
authors.forename: Richard T
authors.initials: RT
authors.lastname: Maziarz
authors.affiliation: Department of Hematology and Oncology, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Matt E
authors.initials: ME
authors.lastname: Kalaycio
authors.affiliation: Department of Medicine, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Wael
authors.initials: W
authors.lastname: Saber
mesh_terms: D061605:Administration, Intravenous; D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D064591:Allografts; D002066:Busulfan / Q000008:administration & dosage*; D003520:Cyclophosphamide / Q000008:administration & dosage*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D019653:Myeloablative Agonists / Q000008:administration & dosage*; D035781:Siblings; D015996:Survival Rate; D019172:Transplantation Conditioning; D014916:Whole-Body Irradiation
chemical_list: D019653:Myeloablative Agonists; D003520:Cyclophosphamide; D002066:Busulfan
keywords: Busulfan; Chronic myeloid leukemia; Total body irradiation