Idarubicin-intensified BUCY2 conditioning regimen improved survival in high-risk acute myeloid, but not lymphocytic leukemia patients undergoing allogeneic hematopoietic stem cell transplantation: A retrospective comparative study. (July 2016)

• Record Type: Journal Article
• Authors: Fang, Jun; Zhang, Ran; Wang, Huafang; Hong, Mei; Wu, Qiuling; Nie, Dimin; You, Yong; Zhong, Zhaodong; Li, Weiming; Hu, Yu; Xia, Linghui
• Is Part Of: Leukemia research. Volume 46(2016:Jul.)
• Page Start: 61
• Page End: 68
• Publication Date: 2016-07
• Subjects: allo-HSCT allogeneic hematopoietic stem cell transplantation -- IDA idarubicin -- AML acute myeloid leukemia -- ALL acute lymphocytic leukemia -- OS overall survival -- DFS disease-free survival -- RR relapse rate -- BU busulfan -- CY cyclophosphamide -- VP-16 etoposide -- CR complete remission -- Ara-C cytarabine -- MLL mixed lineage leukemia -- PBSCs peripheral blood stem cells -- rhG-CSF recombinant human granulocyte colony-stimulating factor -- ANC absolute neutrophil count -- GVHD graft versus host disease -- CsA cyclosporine A -- MTX methotrexate -- MMF mycophenolate mofetil -- TRM transplant-related mortality -- RRM relapse-related mortality -- CML chronic myeloid leukemia -- EBMT European Group for Blood and Marrow Transplantation -- TBI total body irradiation -- HR hazard ratio -- CI confidence interval -- CMV cytomegalovirus -- HVOD hepatic veno-occlusive disease -- NR no remission -- FISH fluorescein in situ hybridization; Idarubicin -- Conditioning regimens -- High-risk acute myeloid leukemia -- High-risk acute lymphocytic leukemia -- Allogeneic hematopoietic stem cell transplantation; Leukemia -- Periodicals; Leukemia -- Periodicals; Leucémie -- Périodiques; Leukemia; Periodicals; Electronic journals; Electronic journals; 616.9941905
• DOI: 10.1016/j.leukres.2016.04.014
• Languages: English
• ISSNs: 0145-2126

Abstract

Highlights: We compared IDA-BUCY2 regimen for high-risk ALL versus AML undergoing allo-HSCT. IDA-BUCY2 regimen reduces relapse of high-risk AML undergoing allo-HSCT, but not ALL. IDA-BUCY2 regimen can improve survival of high-risk AML receiving allo-HSCT. Abstract: The intensity of conditioning regimen is highly correlated with outcomes of allogeneic hematopoietic stem cell transplantation (allo-HSCT). We have previously reported that idarubicin (IDA) intensified BUCY2 regimen could reduce relapse and improve survival for high-risk hematological malignancies undergoing allo-HSCT. However, there is no published study comparing the efficacy of IDA-BUCY2 regimen for high-risk acute myeloid leukemia (AML) versus acute lymphocytic leukemia (ALL). We further retrospectively compared therapeutic outcomes of intensified conditioning regimen on 140 high-risk AML and ALL patients in the data analyses. IDA 15 mg/m 2 /d was administered by continuous infusion from day −11 to −9, followed by intravenous injection of busulfan (BU) (3.2 mg/kg/d) from day −6 to −4, and intravenous injection of cyclophosphamide (CY) (1.8 g/m 2 /d) from day −3 to −2 in IDA-BUCY2 regimen. For high-risk AML, cumulative probabilities of 3-year relapse rates in IDA-BUCY2 and traditional BUCY2 regimens were 16.9%, 43.3% ( P = 0.016). Cumulative probabilities of 3-year overall survival (OS) and disease-free survival (DFS) were 69.2% vs 44.0% ( P = 0.024), and 66.9% vs 38.2% ( P = 0.01). However, two regimens showed no significant differences for high-risk ALL. Multivariate analysis also indicated that IDA intensified BUCY2 conditioning was the favorable variable to reduce relapse and elevate survival for high-risk AML patients. In conclusion, IDA-BUCY2 regimen reduces relapse and improves survival for high-risk AML undergoing allo-HSCT, but not presenting uniform therapeutic effects for high-risk ALL.