The addition of 400 cGY total body irradiation to a regimen incorporating once-daily intravenous busulfan, fludarabine, and antithymocyte globulin reduces relapse without affecting nonrelapse mortality in acute myelogenous leukemia

Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation
James A RussellDouglas A Stewart

Abstract

A combination of fludarabine (Flu) and daily i.v. busulfan (Bu) is well tolerated and effective in patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT) for acute myelogenous leukemia (AML). The addition of rabbit antithymocyte globulin (ATG) may reduce morbidity and mortality from graft-versus-host disease (GVHD), but lead to increased relapse. To compensate for this effect, we added 400 cGy of total body irradiation (TBI) to the Flu/Bu regimen in 89 patients, and compared outcomes with those achieved in 90 patients who received the drug combination alone. Although nonrelapse mortality (NRM) at 3 years did not differ between the groups, the inclusion of TBI significantly reduced relapse (hazard ratio [HR] = 0.29; 95% confidence interval [CI] = 0.15-0.54; P = .0001). Consequently, both overall survival (OS; HR = 0.50; 95% CI = 0.3-0.84; P = .009) and disease-free survival (DFS; HR = 0.43; 95% CI = 0.26-0.72; P = .001) were improved with the inclusion of TBI. This study confirms the importance of regimen intensity in allogeneic HSCT for AML. The combination of daily i.v. Bu, Flu, 400 cGy TBI, and ATG provides a well-tolerated regimen with antileukemic activity in AML comparable to that of other, conventio...Continue Reading

References

Mar 31, 2000·Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation·J A RussellM C Poon
Apr 10, 2002·Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation·E AlyeaR Soiffer
Apr 26, 2006·Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation·Andrea BacigalupoUNKNOWN Gruppo Italiano Trapianti Midollo Osseo (GITMO)
Feb 24, 2007·Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation·James A RussellDouglas Stewart
Jun 21, 2007·Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation·James A RussellDouglas A Stewart
Jun 21, 2007·Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation·Jeannine S McCuneGeorge B McDonald
Nov 21, 2007·Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation·Mary EapenClaudio Anasetti
May 21, 2008·Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation·Borje S AnderssonRichard E Champlin
Aug 12, 2008·Current Pharmaceutical Design·J A Russell, S B Kangarloo
Aug 30, 2008·Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation·Christopher N BredesonDouglas A Stewart

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Citations

Nov 21, 2012·Bone Marrow Transplantation·T L ParkerJ L Bolognia
Nov 20, 2012·Expert Opinion on Drug Metabolism & Toxicology·Ariane Galaup, Angelo Paci
Sep 20, 2011·Best Practice & Research. Clinical Haematology·Avichai Shimoni, Arnon Nagler
Feb 23, 2011·Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation·Gheath AlatrashBorje S Andersson
Dec 10, 2013·Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation·I H BartelinkJaap Jan Boelens
Aug 6, 2010·Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation·Eneida R NemecekH Joachim Deeg
May 24, 2011·Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation·Florent MalardMohamad Mohty
Jul 23, 2013·Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation·James A RussellAndrew Daly
Jun 28, 2016·Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation·Hisashi YamamotoShuichi Taniguchi
Oct 22, 2016·Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation·Hassan SibaiDennis Dong Hwan Kim
Jan 24, 2019·Bone Marrow Transplantation·Shin-Ichiro FujiwaraUNKNOWN HLA Working Group of the Japan Society for Hematopoietic Cell Transplantation
Feb 16, 2017·Transplant Infectious Disease : an Official Journal of the Transplantation Society·Wilson LamAndrew Daly

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