A comparison of cyclophosphamide and total body irradiation with etoposide and total body irradiation as patients conditioning regimens for undergoing sibling allografting for acute lymphoblastic leukemia in first or second complete remission
A comparison of cyclophosphamide and total body irradiation with etoposide and total body irradiation as patients conditioning regimens for undergoing sibling allografting for acute lymphoblastic leukemia in first or second complete remission
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DOI：
10.1016/j.bbmt.2005.12.029
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发表时间：
2006-04-01
影响因子：
4.3
通讯作者：
Horowitz, MM
中科院分区：
文献类型：
--
作者：
Marks, DI;Forman, SJ;Horowitz, MM
我们比较了298例首次或第二次完全缓解（CR 1或CR2）的急性淋巴细胞白血病患者在环磷酰胺和全身照射（Cy-TBI）预处理后接受HLA匹配同胞同种异体移植的结局，以及204例接受依托泊苷和TBI的患者。因此，比较了4组：Cy-TBI < 13戈伊（n = 217），Cy-TBI >= 13戈伊（n = 81），依托泊苷-TBI < 13戈伊（n = 53）和依托泊苷-TBI>= 13戈伊（n = 151）。分别对CR 1和CR2移植的复发、无白血病生存期（LFS）和生存期进行分析。预处理方案的移植相关死亡率无差异。在CR 1中，不同预处理方案的复发率、LFS或生存率也无显著差异。在CR2中，这些结果在调节组之间存在差异。与Cy-TBI < 13戈伊相比，依托泊苷（无论TBI剂量如何）或TBI剂量>= 13戈伊的复发、治疗失败（LFS的倒数）和死亡率的风险倾向于较低。对于CR 1和CR2移植，各组的死亡原因相似;疾病复发占死亡的47%。我们的结论是，对于HLA相同的同胞同种异体移植物的急性淋巴细胞白血病的CR2，有一个优势，在取代依托泊苷Cy或，当Cy使用，在增加TBI剂量>= 13戈伊。(C)2006年美国血液和骨髓移植协会。
We compared the outcomes of 298 patients with acute lymphoblastic leukemia in first or second complete remission (CR1 or CR2) receiving HLA-matched sibling allografts after cyclophosphamide and total body irradiation (Cy-TBI) conditioning with 204 patients receiving etoposide and TBI. Consequently, 4 groups were compared: Cy-TBI < 13 Gy (n = 217), Cy-TBI >= 13 Gy (n = 81), etoposide-TBI < 13 Gy (n = 53), and etoposide-TBI >= 13 Gy (n = 151). Analyses of relapse, leukemia-free survival (LFS), and survival were performed separately for CR1 and CR2 transplantations. Transplant-related mortality did not differ by conditioning regimen. In CR1, there were also no significant differences in relapse, LFS, or survival by conditioning regimen. In CR2, these outcomes differed among conditioning groups. In comparison with Cy-TBI < 13 Gy, the risks of relapse, treatment failure (inverse of LFS), and mortality tended to be lower with etoposide (regardless of TBI dose) or with TBI doses >= 13 Gy. For both CR1 and CR2 transplantations, causes of death were similar among the groups; disease recurrence accounted for 47% of deaths. We conclude that for HLA-identical sibling allografts for acute lymphoblastic leukemia in CR2, there is an advantage in substituting etoposide for Cy or, when Cy is used, in increasing the TBI dose to >= 13 Gy. (C) 2006 American Society fir Blood and Marrow Transplantation.