Comparison of outcomes of idarubicin intensified TBI-CY and traditional TBI-CY conditioning regimen for high-risk acute lymphoblastic leukemia undergoing allogeneic hematopoietic stem cell transplantation: A single center experience

Qiuling Wu; Ran Zhang; Huafang Wang; Yong You; Zhaodong Zhong; Mei Hong; Jun Fang; Weiming Li; Wei Shi; Xuan Lu; Yu Hu; Linghui Xia

doi:10.1016/j.leukres.2015.08.015

Comparison of outcomes of idarubicin intensified TBI-CY and traditional TBI-CY conditioning regimen for high-risk acute lymphoblastic leukemia undergoing allogeneic hematopoietic stem cell transplantation: A single center experience

Leuk Res. 2015 Aug 28:S0145-2126(15)30369-6. doi: 10.1016/j.leukres.2015.08.015. Online ahead of print.

Authors

Qiuling Wu¹, Ran Zhang¹, Huafang Wang¹, Yong You¹, Zhaodong Zhong¹, Mei Hong¹, Jun Fang¹, Weiming Li¹, Wei Shi¹, Xuan Lu¹, Yu Hu¹, Linghui Xia²

Affiliations

¹ Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan China.
² Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan China. Electronic address: xlh64@medmail.com.cn.

PMID: 26340915
DOI: 10.1016/j.leukres.2015.08.015

Abstract

High-risk acute lymphoblastic leukemia (ALL) carries a very poor prognosis, even after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Exploring novel conditioning regimen to more effectively eliminate leukemic clone while not alter transplant-related mortality (TRM) has become focus of attention. We retrospectively evaluated outcomes of 87 high-risk ALL patients undergoing allo-HSCT: 47 patients received idarubicin (IDA) intensified TBI-CY and 40 patients received traditional TBI-CY regimen. In IDA intensified group, patients received TBI (8Gy) on day-8, IDA of 15mg/m²/d from day-6 to -5, followed by CY (60mg/kg/d) on day-3 to -2. The cumulative incidence of relapse was significantly lower in IDA intensified group compared with TBI-CY group (P=0.018). Oropharyngeal mucositis was observed more frequent in IDA intensified group (P=0.013), while not followed by increased TRM. Very high-risk ALL patients benefit from IDA intensified regimen with only two of eight patients in no remission (NR) pre-transplantation and two of twelve ph⁺ALL patients relapsed after transplantation. After a median follow-up for all survivors of 21 months (range, 12-53 months), 2-year estimated OS and DFS was 66.2% vs 45.3% (P=0.031) and 62.5% vs 43.5% (P=0.044), respectively. In conclusion, IDA intensified TBI-CY regimen may reduce relapse while not increasing TRM, providing better survival for high-risk ALL patients undergoing allo-HSCT.

Keywords: Allogeneic hematopoietic stem cell transplantation; High-risk acute lymphoblastic leukemia; Idarubicin; Intensified conditioning regimen; Total body irradiation.