title: A Safety and Efficacy Study of Medium-Dose Etoposide, Cyclophosphamide and Total Body Irradiation Conditioning Before Allogeneic Stem Cell Transplantation for Acute Lymphoblastic Leukemia.
abstract: Prognosis for adult patients with acute lymphoblastic leukemia (ALL) has been reported to be approximately 35% to 50%, even after allogeneic stem cell transplantation (allo-SCT). We previously reported retrospective analyses of a conditioning regimen of medium-dose etoposide, cyclophosphamide (CY), and total body irradiation (TBI) before allo-SCT for ALL. To prospectively analyze the efficacy of this conditioning regimen, we conducted a trial prospectively.
  
  
  METHODS
  The eligibility criteria of this study were as follows: diagnosis of ALL, aged between 15 and 50 years, in complete remission, and first SCT from HLA serologically matched donor. The primary endpoint of this study was event-free survival at 1 year after SCT, and the events were defined as death and relapse.
  
  
  RESULTS
  Fifty eligible patients were treated, and the median age of the patients was 33.5 years. Nineteen patients were Philadelphia chromosome-positive, and 47 were in first complete remission at SCT. All patients achieved neutrophil engraftment. Grade 3 to 4 acute graft-versus-host disease and extensive chronic graft-versus-host disease developed in 4 patients and 18 patients, respectively. No patient died within 100 days after SCT. One-year event-free survival was 76.0%, and 1-year overall survival was 80.0%. The cumulative incidences of relapse and non-relapse mortality at 1-year after SCT were 10.0% and 14.0%, respectively.
  
  
  CONCLUSIONS
  Medium-dose etoposide + CY + TBI is an effective conditioning before allo-SCT for adult patients with ALL, enabling good disease control without an increase in nonrelapse mortality. A phase 3 trial comparing this regimen with the standard CY + TBI regimen for adult patients with ALL is warranted.
authors: Department of Hematology, Hokkaido University, Sapporo, Japan.
authors: Akio
authors: A
authors: Shigematsu
authors: Department of Hematology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan.
authors: Yukiyasu
authors: Y
authors: Ozawa
authors: Department of Hematology and Oncology, Tokai University School of Medicine, Kanagawa, Japan.
authors: Makoto
authors: M
authors: Onizuka
authors: Department of Hematology, Yokohama City University Medical Center, Yokohama, Japan.
authors: Shin
authors: S
authors: Fujisawa
authors: Department of HSCT Data Management and Biostatistics, Nagoya University, Nagoya, Japan.
authors: Ritsuro
authors: R
authors: Suzuki
authors: Department of HSCT Data Management and Biostatistics, Nagoya University, Nagoya, Japan.
authors: Yoshiko
authors: Y
authors: Atsuta
authors: Department of Hematology/Oncology, Wakayama Medical University Hospital, Wakayama, Japan.
authors: Kazuo
authors: K
authors: Hatanaka
authors: Division of Bone Marrow Transplantation, Niigata University Medical and Dental Hospital, Niigata, Japan.
authors: Masayoshi
authors: M
authors: Masuko
authors: Division of Hematology, Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan.
authors: Toshiro
authors: T
authors: Ito
authors: Division of Hematology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.
authors: Naoki
authors: N
authors: Kobayashi
authors: Division of Hematology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.
authors: Jun
authors: J
authors: Kato
authors: Department of Hematology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan.
authors: Koichi
authors: K
authors: Miyamura
authors: Stem Cell Transplantation Division, National Cancer Center Hospital, Tokyo, Japan.
authors: Takahiro
authors: T
authors: Fukuda
authors: Department of Hematology and Cell Therapy, Aichi Cancer Center Hospital, Nagoya, Japan.
authors: Yasuo
authors: Y
authors: Morishima
authors: Department of Hematology, Sapporo Hokuyu Hospital, Sapporo, Japan.
authors: Masahiro
authors: M
authors: Imamura