TY - JOUR
T1 - Comparison of a fludarabine and melphalan combination-based reduced toxicity conditioning with myeloablative conditioning by radiation and/or busulfan in acute myeloid leukemia in Japanese children and adolescents
AU - Ishida, Hiroyuki
AU - Adachi, Souichi
AU - Hasegawa, Daiichiro
AU - Okamoto, Yasuhiro
AU - Goto, Hiroaki
AU - Inagaki, Jiro
AU - Inoue, Masami
AU - Koh, Katsuyoshi
AU - Yabe, Hiromasa
AU - Kawa, Keisei
AU - Kato, Koji
AU - Atsuta, Yoshiko
AU - Kudo, Kazuko
N1 - Publisher Copyright:
© 2014 Wiley Periodicals, Inc.
PY - 2015/5/1
Y1 - 2015/5/1
N2 - The relative efficacy of allogeneic hematopoietic cell transplantation (allo-HCT) after reduced toxicity conditioning (RTC) compared with standard myeloablative conditioning (MAC) in pediatric patients with acute myeloid leukemia (AML) has not been studied extensively. To address whether RTC is a feasible approach for pediatric patients with AML in remission, we performed a retrospective investigation of the outcomes of the first transplant in patients who had received an allo-HCT after RTC or standard MAC, using nationwide registration data collected between 2000 and 2011 in Japan. Procedure: We compared a fludarabine (Flu) and melphalan (Mel)-based regimen (RTC; n=34) with total body irradiation (TBI) and/or busulfan (Bu)-based conditioning (MAC; n=102) in demographic- and disease-criteria-matched childhood and adolescent patients with AML in first or second complete remission (CR1/CR2). Results: The incidence of engraftment, early complications, grade II-IV acute graft-versus-host disease (GVHD), and chronic GVHD were similar in each conditioning group. The risk of relapse (25% vs. 26%) and non-relapse mortality (13% vs. 11%) after 3 years did not differ between these groups, and univariate and multivariate analyses demonstrated that the 3-year overall survival (OS) rates after Flu/Mel-RTC and MAC were comparable (mean, 72% [range, 51-85%] and 68% [range, 58-77%], respectively). Conclusions: The results suggest that the Flu/Mel-RTC regimen is a clinically acceptable conditioning strategy for childhood and adolescent patients with AML in remission. Although this retrospective, registry-based analysis has several limitations, RTC deserves to be further investigated in prospective trials. Pediatr Blood Cancer 2015;62:883-889.
AB - The relative efficacy of allogeneic hematopoietic cell transplantation (allo-HCT) after reduced toxicity conditioning (RTC) compared with standard myeloablative conditioning (MAC) in pediatric patients with acute myeloid leukemia (AML) has not been studied extensively. To address whether RTC is a feasible approach for pediatric patients with AML in remission, we performed a retrospective investigation of the outcomes of the first transplant in patients who had received an allo-HCT after RTC or standard MAC, using nationwide registration data collected between 2000 and 2011 in Japan. Procedure: We compared a fludarabine (Flu) and melphalan (Mel)-based regimen (RTC; n=34) with total body irradiation (TBI) and/or busulfan (Bu)-based conditioning (MAC; n=102) in demographic- and disease-criteria-matched childhood and adolescent patients with AML in first or second complete remission (CR1/CR2). Results: The incidence of engraftment, early complications, grade II-IV acute graft-versus-host disease (GVHD), and chronic GVHD were similar in each conditioning group. The risk of relapse (25% vs. 26%) and non-relapse mortality (13% vs. 11%) after 3 years did not differ between these groups, and univariate and multivariate analyses demonstrated that the 3-year overall survival (OS) rates after Flu/Mel-RTC and MAC were comparable (mean, 72% [range, 51-85%] and 68% [range, 58-77%], respectively). Conclusions: The results suggest that the Flu/Mel-RTC regimen is a clinically acceptable conditioning strategy for childhood and adolescent patients with AML in remission. Although this retrospective, registry-based analysis has several limitations, RTC deserves to be further investigated in prospective trials. Pediatr Blood Cancer 2015;62:883-889.
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U2 - 10.1002/pbc.25389
DO - 10.1002/pbc.25389
M3 - Article
C2 - 25545836
AN - SCOPUS:84925363589
VL - 62
SP - 883
EP - 889
JO - Medical and Pediatric Oncology
JF - Medical and Pediatric Oncology
SN - 1545-5009
IS - 5
ER -