Fludarabine or cyclophosphamide in combination with total body irradiation as myeloablative conditioning prior to allogeneic hematopoietic cell transplantation for acute lymphoblastic leukemia: an analysis by the Acute Leukemia Working Party of the EBMT.

Date publication

février 2023

Journal

Bone marrow transplantation

Auteurs

Membres identifiés du Cancéropôle Est :
Dr LIOURE Bruno

Tous les auteurs :
Giebel S, Labopin M, Socié G, Aljurf M, Salmenniemi U, Labussière-Wallet H, Srour M, Kröger N, Zahrani MA, Lioure B, Reményi P, Arat M, Bourhis JH, Helbig G, Tbakhi A, Forcade E, Huynh A, Brissot E, Spirydonidis A, Savani BN, Peric Z, Nagler A, Mohty M

Lien Pubmed

https://www.ncbi.nlm.nih.gov/pubmed/36725978

Résumé

In this registry-based study we retrospectively compared outcomes of allogeneic hematopoietic cell transplantation (allo-HCT) for adult patients with acute lymphoblastic leukemia (ALL) following conditioning with total body irradiation (TBI) combined with either cyclophosphamide (Cy) or fludarabine (Flu). TBI 12 Gy + Cy was used in 2105 cases while TBI 12 Gy + Flu was administered to 150 patients in first or second complete remission. In a multivariate model adjusted for other prognostic factors, TBI/Cy conditioning was associated with a reduced risk of relapse (HR = 0.69, p = 0.049) and increased risk of grade 2-4 acute graft-versus-host disease (GVHD, HR = 1.57, p = 0.03) without significant effect on other transplantation outcomes. In a matched-pair analysis the use of TBI/Cy as compared to TBI/Flu was associated with a significantly reduced rate of relapse (18% vs. 30% at 2 years, p = 0.015) without significant effect on non-relapse mortality, GVHD and survival. We conclude that the use of myeloablative TBI/Cy as conditioning prior to allo-HCT for adult patients with ALL in complete remission is associated with lower risk of relapse rate compared to TBI/Flu and therefore should probably be considered a preferable regimen.

Référence

Bone Marrow Transplant. 2023 02 1;: