Impact of Conditioning Regimen on Outcomes for Children with Acute Myeloid Leukemia Undergoing Transplantation in First Complete Remission. An Analysis on Behalf of the Pediatric Disease Working Party of the European Group for Blood and Marrow Transplantation

被引：41

作者：

Lucchini, Giovanna ^{[1
]}

Labopin, Myriam ^{[2
]}

Beohou, Eric ^{[2
]}

Dalissier, Arnauld ^{[2
]}

Dalle, Jean Hughes ^{[3
]}

Cornish, Jacqueline ^{[4
]}

Zecca, Marco ^{[5
]}

Samarasinghe, Sujith ^{[1
]}

Gibson, Brenda ^{[6
]}

Locatelli, Franco ^{[7
]}

Bertrand, Yves ^{[8
]}

Abdel-Rahman, Fawzi ^{[9
]}

Socie, Gerald ^{[10
]}

Sundin, Mikael ^{[11
]}

Lankester, Arjan ^{[12
]}

Sedlacek, Peter ^{[13
]}

Hamladji, Rose Marie ^{[14
]}

Heilmann, Carsten ^{[15
]}

Afanasyev, Boris ^{[16
]}

Hough, Rachel ^{[17
]}

Peters, Cristina ^{[18
]}

Bader, Peter ^{[19
]}

Veys, Paul ^{[1
]}

机构：

[1] Great Ormond St Hosp Sick Children, Dept Bone Marrow Transplant, London, England

[2] Univ Paris 06, Blood & Marrow Transplantat Off, BMT Stat Unit, European Grp, Paris, France

[3] Hop Robert Debre, Hematoimmunol Dept, Paris, France

[4] Bristol Royal Hosp Children, Paediat Haematol Oncol Dept, Bristol, Avon, England

[5] Fdn IRCCS Policlin San Matteo, Pediat Hematol Oncol Dept, Pavia, Italy

[6] Royal Hosp Sick Children, Dept Haematol, Glasgow, Lanark, Scotland

[7] IRCCS Bambino Gesu Children Hosp, Pediat Hematol Oncol Dept, Rome, Italy

[8] Inst Hematol & Oncol Pediat, Pediat Hematol & Oncol Dept, Lyon, France

[9] King Hussein Canc Ctr, Bone Marrow & Stem Cell Transplantat Dept, Amman, Jordan

[10] Hop St Louis, Hematol Transplantat Dept, Paris, France

[11] Karolinska Univ Hosp, Astrid Lindgren Childrens Hosp, Hematol Immunol SCT Dept, Stockholm, Sweden

[12] Leiden Univ Hosp, Div Immunohematol & Stem Cell Transplantat, Dept Pediat, Leiden, Netherlands

[13] Univ Hosp Motol, Paediat Haematol & Oncol Dept, Prague, Czech Republic

[14] Ctr Pierre & Marie Curie, Dept Hematol, Algiers, Algeria

[15] Rigshosp, Paediat & Adolescent Med Dept, Copenhagen, Denmark

[16] St Petersburg State Med Pavlov Univ, Ratsa Gorbacheva Mem Childrens Inst, Hematol & Transplantol Dept, St Petersburg, Russia

[17] Univ Coll Hosp, Stem Cell Transplantat Dept, London, England

[18] St Anna Childrens Hosp, Stem Cell Transplantat Dept, Vienna, Austria

[19] Goethe Univ, Univ Frankfurt Klinikum, Stem Cell Transplantat & Immunol Dept, Frankfurt, Germany

来源：

BIOLOGY OF BLOOD AND MARROW TRANSPLANTATION | 2017年 / 23卷 / 03期

关键词：

TOTAL-BODY IRRADIATION; HEMATOPOIETIC-CELL TRANSPLANTATION; ACUTE MYELOBLASTIC-LEUKEMIA; VERSUS-HOST-DISEASE; RANDOMIZED-TRIAL; BUSULFAN; AML; CYCLOPHOSPHAMIDE; MELPHALAN; GREFFE;

D O I：

10.1016/j.bbmt.2016.11.022

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Hematopoietic stem cell transplantation (HSCT) represents the cornerstone of treatment in pediatric high risk and relapsed acute myeloid leukemia (AML). The aim of the present study was to compare outcomes of pediatric patients with AML undergoing HSCT using 3 different conditioning regimens: total body irradiation (TBI) and cyclophosphamide (Cy); busulfan (Bu) and Cy; or Bu, Cy, and melphalan (Mel). In this retrospective study, registry data for patients > 2 and <18 years age undergoing matched allogeneic HSCT for AML in first complete remission (CR1) in 204 European Group for Blood and Marrow Transplantation centers between 2000 and 2010 were analyzed. Data were available for 631 patients; 458 patients received stem cells from a matched sibling donor and 173 from a matched unrelated donor. For 440 patients, bone marrow was used as stem cell source, and 191 patients received peripheral blood stem cells. One hundred nine patients received TBICy, 389 received BuCy, and 133 received BuCyMel as their preparatory regimen. Median follow-up was 55 months. Patients receiving BuCyMel showed a lower incidence of relapse at 5 years (14.7% versus 31.5% in BuCy versus 30% in TBICy, P <.01) and higher overall survival (OS) (76.6% versus 64% versus 64.5%, P =.04) and leukemia-free survival (LFS) (74.5% versus 58% versus 61.9%, P <.01), with a comparable nonrelapse mortality (NRM) (10.8% versus 10.5% versus 8.1%, P =.79). Acute graft-versus-host disease (GVHD) grades III and IV but not chronic GVHD, was higher in patients receiving BuCyMel. Older age at HSCT had an adverse impact on NRM and the use of peripheral blood as stem cell source was associated with increased chronic GVHD and NRM as well as lower LFS and OS. Among pediatric patients receiving HSCT for AML in CR1, the use of BuCyMel conditioning proved superior to TBICy and BuCy in reducing relapse and improving LFS. (C) 2017 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.

引用

页码：467 / 474

页数：8

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