title: Thiotepa-based versus total body irradiation-based myeloablative conditioning prior to allogeneic stem cell transplantation for acute myeloid leukaemia in first complete remission: a retrospective analysis from the Acute Leukemia Working Party of the European Group for Blood and Marrow Transplantation.
abstract: Thiotepa is an alkylating compound with an antineoplastic and myeloablative activity and can mimic the effect of radiation. However, it is unknown whether this new regimen could safely replace the long-established ones. This retrospective matched-pair analysis evaluated the outcome of adults with acute myeloid leukaemia in first complete remission who received myeloablative conditioning either with a thiotepa-based (n = 121) or a cyclophosphamide/total body irradiation-based (TBI; n = 358) regimen for allogeneic hematopoietic stem cell transplantation from an HLA-matched sibling or an unrelated donor. With a median follow-up of 44 months, the outcome was similar in both groups. Acute graft-versus-host disease grade II-IV was observed in 25% after thiotepa-containing regimen versus 35% after TBI (P = 0.06). The 2-yr cumulative incidence of chronic graft-versus-host disease was 40.5% for thiotepa and 41% for TBI (P = 0.98). At 2 yrs, the cumulative incidences of non-relapse mortality and relapse incidence were 23.9% (thiotepa) vs. 22.4% (TBI; P = 0.66) and 17.2% (thiotepa) vs. 23.3% (TBI; P = 0.77), respectively. The probabilities of leukaemia-free and overall survival at 2 yrs were not significantly different between the thiotepa and TBI groups, at 58.9% vs. 54.2% (P = 0.95) and 61.4% vs. 58% (P = 0.72), respectively. Myeloablative regimens using combinations including thiotepa can provide satisfactory outcomes, but the optimal conditioning remains unclear for the individual patient in this setting.
authors: EBMT Office Paris, Hôpital Saint-Antoine, Paris, France.
authors: Sandra
authors: S
authors: Eder
authors: EBMT Office Paris, Hôpital Saint-Antoine, Paris, France.
authors: Myriam
authors: M
authors: Labopin
authors: Rome Transplant Network "Tor Vergata", University of Rome Stem Cell Transplant Unit, Rome, Italy.
authors: William
authors: W
authors: Arcese
authors: Department of Bone Marrow Transplantation, Hadassah University Hospital, Jerusalem, Israel.
authors: Reuven
authors: R
authors: Or
authors: Haematology & SCT Unit, Ospedale S. Camillo, Rome, Italy.
authors: Ignazio
authors: I
authors: Majolino
authors: Department of Haematology II, Ospedale San Martino, Genova, Italy.
authors: Andrea
authors: A
authors: Bacigalupo
authors: Division of Hematology, University of Napoli Federico II Medical School, Napoli, Italy.
authors: Gennaro
authors: G
authors: de Rosa
authors: Helsinki University Central Hospital, Helsinki, Finland.
authors: Liisa
authors: L
authors: Volin
authors: Department of Bone Marrow Transplantation, University Hospital of Essen, Essen, Germany.
authors: Dietrich
authors: D
authors: Beelen
authors: Department of Hematology, Leiden University Medical Center, Leiden, The Netherlands.
authors: Hendrik
authors: H
authors: Veelken
authors: Department of Hematology, Radboud University Medical Centre, Nijmegen, The Netherlands.
authors: Nicolaas P M
authors: NP
authors: Schaap
authors: Department of Haematology, University Medical Centre, Utrecht, The Netherlands.
authors: Jurgen
authors: J
authors: Kuball
authors: Erasmus MC-Daniel den Hoed Cancer Centre, Rotterdam, The Netherlands.
authors: Jan
authors: J
authors: Cornelissen
authors: Chaim Sheba Medical Center, Tel Hashomer, Israel.
authors: Arnon
authors: A
authors: Nagler
authors: Service d'Hématologie et Thérapie Cellulaire, Hôpital Saint Antoine, Paris, France.
authors: Mohamad
authors: M
authors: Mohty
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003520:Cyclophosphamide / Q000008:administration & dosage; D018572:Disease-Free Survival; D006086:Graft vs Host Disease / Q000401:mortality / Q000517:prevention & control; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D015994:Incidence; D015470:Leukemia, Myeloid, Acute / Q000401:mortality / Q000628:therapy; D008875:Middle Aged; D035781:Siblings; D015996:Survival Rate; D013852:Thiotepa / Q000008:administration & dosage*; D019172:Transplantation Conditioning / Q000379:methods*; D061349:Unrelated Donors; D014916:Whole-Body Irradiation
chemical_list: D003520:Cyclophosphamide; D013852:Thiotepa
keywords: acute myeloid leukaemia; allo-HSCT; thiotepa; total body irradiation