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Reduced-Intensity Conditioning with Busulfan and Fludarabine for Allogeneic Hematopoietic Stem Cell Transplantation in Acute Lymphoblastic Leukemia

Yonsei Medical Journal 2020년 61권 6호 p.452 ~ 459
이승신 ( Lee Seung-Shin ) - Wonkwang University Hospital Department of Hematology-Oncology

정성훈 ( Jung Sung-Hoon ) - Chonnam National University Hwasun Hospital Department of Hematology-Oncology
도영록 ( Do Young-Rok ) - Keimyung University School of Medicine Dongsan Medical Center Department of Internal Medicine Division of Hematology/Oncology
김대식 ( Kim Dae-Sik ) - Korea University Guro Hospital Department of Internal Medicine
이지현 ( Lee Ji-Hyun ) - Dong-A University College of Medicine Department of Internal Medicine
박한승 ( Park Han-Seung ) - University of Ulsan College of Medicine Asan Medical Center Department of Hematology
문준호 ( Moon Joon-Ho ) - Kyungpook National University School of Medicine Kyungpook National University Hospital Department of Oncology/Hematology
이준호 ( Yi Jun-Ho ) - Chung-Ang University College of Medicine Department of Medicine
 ( Park Yong ) - Korea University Anam Hospital Department of Internal Medicine
고영일 ( Koh Young-Il ) - Seoul National University College of Medicine Seoul National University Hospital Department of Internal Medicine
임호영 ( Yhim Ho-Young ) - Chonbuk National University Medical School Chonbuk National University Hospital Department of Internal Medicine
최윤숙 ( Choi Yun-Suk ) - University of Ulsan College of Medicine Ulsan University Hospital Department of Hematology and Oncology
문영철 ( Mun Yeung-Chul ) - Ewha Womans University School of Medicine Department of Internal Medicine
이원식 ( Lee Won-Sik ) - Inje University Busan Paik Hospital Department of Hemato-Oncology
이석 ( Lee Seok ) - Catholic University College of Medicine Seoul St. Mary’s Hospital Department of Hematology
양덕환 ( Yang Deok-Hwan ) - Chonnam National University Hwasun Hospital Department of Hematology-Oncology

Abstract


Purpose: Allogeneic hematopoietic stem cell transplantation (HSCT) with optimal conditioning has helped better long-term survival in acute lymphoblastic leukemia (ALL). This study investigated the efficacy and safety of reduced-intensity conditioning (RIC) with busulfan and fludarabine in adult ALL patients unfit for myeloablation.

Materials and Methods: Records of 78 patients who underwent HSCT with RIC consisting of 3.2 mg/kg/day of busulfan for 2 or 3 days and 30 mg/m2/day of fludarabine for 5 or 6 days were analyzed.

Results: The median age at diagnosis was 49 years. Over a median follow-up of 22 months, 2-year estimates of relapse-free survival (RFS) and overall survival were 57.4% and 68.7%, respectively. Multivariate analysis showed a trend of improved RFS in patients with chronic graft-versus-host disease (GVHD) (hazard ratio, 0.53; 95% confidence interval, 0.26?1.08; p=0.080). The cumulative incidences of relapse and non-relapse mortality were 42.9% and 19.6%, respectively and one case of central nervous system relapse was noted. No hepatic veno-occlusive disease was reported. Grade II?IV acute GVHD and any grade chronic GVHD occurred in 21.1% and 41.7%, respectively.

Conclusion: RIC with busulfan and fludarabine is an effective and safe conditioning regimen for adult ALL patients unfit for myeloablation.

키워드

Fludarabine; busulfan; lymphoblastic leukemia; stem cell transplantation; transplantation conditioning
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