| Title: |
Total body irradiation versus busulfan based intermediate intensity conditioning for stem cell transplantation in ALL patients >45 years—a registry-based study by the Acute Leukemia Working Party of the EBMT |
| Authors: |
Hirschbuhl K.; Labopin M.; Polge E.; Blaise D.; Bourhis J. H.; Socie G.; Forcade E.; Yakoub-Agha I.; Labussiere-Wallet H.; Bethge W.; Chevallier P.; Bonnet S.; Stelljes M.; Spyridonidis A.; Peric Z.; Brissot E.; Savani B.; Giebel S.; Schmid C.; Ciceri F.; Nagler A.; Mohty M. |
| Contributors: |
Hirschbuhl, K.; Labopin, M.; Polge, E.; Blaise, D.; Bourhis, J. H.; Socie, G.; Forcade, E.; Yakoub-Agha, I.; Labussiere-Wallet, H.; Bethge, W.; Chevallier, P.; Bonnet, S.; Stelljes, M.; Spyridonidis, A.; Peric, Z.; Brissot, E.; Savani, B.; Giebel, S.; Schmid, C.; Ciceri, F.; Nagler, A.; Mohty, M. |
| Publisher Information: |
Springer Nature |
| Publication Year: |
2023 |
| Description: |
Allogeneic hematopoietic cell transplantation is a potentially curative treatment in high-risk acute lymphoblastic leukemia (ALL). Conditioning regimens based on ≥12 Gray total body irradiation (TBI) represent the current standard in patients ≤45 years, whereas elderly patients frequently receive intermediate intensity conditioning (IIC) to reduce toxicity. To evaluate the role of TBI as a backbone of IIC in ALL, a retrospective, registry-based study included patients >45 years transplanted from matched donors in first complete remission, who had received either fludarabine/TBI 8 Gy (FluTBI8, n = 262), or the most popular, irradiation-free alternative fludarabine/busulfan, comprising busulfan 6.4 mg/kg (FluBu6.4, n = 188) or 9.6 mg/kg (FluBu9.6, n = 51). At two years, overall survival (OS) was 68.5%, 57%, and 62.2%, leukemia-free survival (LFS) was 58%, 42.7%, and 45%, relapse incidence (RI) was 27.2%, 40%, and 30.9%, and non-relapse-mortality (NRM) was 23.1%, 20.7%, and 26.8% for patients receiving FluTBI8Gy, FluBu6.4, and FluBu9.6, respectively. In multivariate analysis, the risk of NRM, acute and chronic graft-versus-host disease was not influenced by conditioning. However, RI was higher after FluBu6.4 (hazard ratio [HR] [95% CI]: 1.85 [1.16–2.95]), and LFS was lower after both FluBu6.4 (HR: 1.56 [1.09–2.23]) and FluBu9.6 (HR: 1.63 [1.02–2.58]) as compared to FluTBI8. Although only resulting in a non-significant advantage in OS, this observation indicates a stronger anti-leukemic efficacy of TBI-based intermediate intensity conditioning. |
| Document Type: |
article in journal/newspaper |
| Language: |
English |
| Relation: |
info:eu-repo/semantics/altIdentifier/pmid/37147469; info:eu-repo/semantics/altIdentifier/wos/WOS:000982735700001; journal:BONE MARROW TRANSPLANTATION; https://hdl.handle.net/20.500.11768/149437 |
| DOI: |
10.1038/s41409-023-01966-w |
| Availability: |
https://hdl.handle.net/20.500.11768/149437; https://doi.org/10.1038/s41409-023-01966-w; https://www.nature.com/articles/s41409-023-01966-w |
| Rights: |
info:eu-repo/semantics/openAccess ; license:Creative commons ; license uri:http://creativecommons.org/licenses/by/4.0/ |
| Accession Number: |
edsbas.1629BC7 |
| Database: |
BASE |