In a nutshell
This study aimed to compare two conditioning treatment regimens for adult patients with Ph-negative acute lymphoblastic leukemia treated with stem cell transplant.
This study concluded that the regimen that combined etoposide (Etopophos) and total body irradiation was more effective than the regimen that combined cyclophosphamide (Neosar) and total body irradiation in these patients.
Some background
Allogeneic hematopoietic stem cell transplantation (alloHSCT, using donor stem cells) with total body irradiation (TBI) is commonly used for the treatment of adults with acute lymphoblastic leukemia (ALL). TBI suppresses the immune system to achieve successful SCT. TBI is usually combined with cyclophosphamide (Cy/TBI) or etoposide (Vp/TBI). Both cyclophosphamide and etoposide are chemotherapies.
It was not known which regimen, Cy/TBI or Vp/TBI, would be more effective in adult patients with Ph-negative ALL.
Methods & findings
This study involved information on 1498 adult patients with Ph-negative ALL treated with alloHSCT in their first or second complete remission. Patients received Cy/TBI (1346) or Vp/TBI (152). The two treatment regimens were compared. Patients were followed for an average of 60 months.
The incidence of relapse (cancer reoccurring) at 5 years was 17% for the Vp/TBI group compared to 30% for the Cy/TBI group. The rate of leukemia-free survival was 60% for the Vp/TBI group compared to 50% for the Cy/TBI group. The rate of graft-versus-host-disease (GVHD, a condition where the transplanted cells attack healthy tissue) and relapse free survival was 43% in the Vp/TBI group compared to 33% in the Cy/TBI group.
The incidence of non-relapse mortality was similar in both groups. The incidence of acute or chronic GVHD was similar in both groups. The use of Vp/TBI was associated with reduced risk of relapse.
The bottom line
This study concluded that the Vp/TBI conditioning regimen is more effective than the Cy/TBI conditioning regimen for adult patients with Ph-negative ALL treated with alloHSCT.
The fine print
The limitation to this study is that there was a lack of information on the side effects of these regimens.
What’s next?
Consult your physician about which conditioning regimen is best for you.
Published By :
American Journal of Hematology
Date :
Mar 25, 2018
