Impact of Conditioning Regimen in Allogeneic Hematopoetic Stem Cell Transplantation for Children with Acute Myelogenous Leukemia beyond First Complete Remission

A Pediatric Blood and Marrow Transplant Consortium (PBMTC) Study

India Y. Sisler, Elizabeth Koehler, Tatsuki Koyama, Jennifer A. Domm, Robin Ryan, John E. Levine, Michael A. Pulsipher, Paul R. Haut, Kirk R. Schultz, Douglas S. Taylor, Haydar A. Frangoul

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Total body irradiation (TBI)-based conditioning regimens for pediatric patients with acute myelogenous leukemia (AML) beyond first complete remission (CR1) are controversial. Because the long-term morbidity of busulfan (Bu)-based regimens appears to be lower, determining efficacy is critical. We retrospectively evaluated 151 pediatric patients with AML beyond CR1, comparing outcomes in 90 patients who received a TBI-based conditioning regimen and 61 patients who received a Bu-based conditioning regimen. There were no differences between the 2 groups with respect to age, sex, duration of CR1, time from most recent remission to transplantation, or donor source. The probability of relapse at 2 years also did not differ between the 2 groups (26% and 27%, respectively; P=.93). No significant difference in event-free survival (EFS) (P=.29) or overall survival (OS) (P=.11) was noted between the 2 groups. These findings were supported by a multivariate analysis in which TBI was not associated with improved EFS (hazard ratio [HR]=1.17; 95% confidence interval [CI]=0.66-2.10; P=.58) or OS (HR=1.42; 95% CI=0.76-2.64; P=.27). Shorter CR1 and receiving an HLA-mismatched transplant adversely affected EFS and OS in this cohort. Our study provides no evidence of an advantage to using TBI in children with AML beyond CR1. A prospective, randomized study is needed to confirm these results.

Original languageEnglish (US)
Pages (from-to)1620-1627
Number of pages8
JournalBiology of Blood and Marrow Transplantation
Volume15
Issue number12
DOIs
StatePublished - Dec 2009

Fingerprint

Whole-Body Irradiation
Stem Cell Transplantation
Acute Myeloid Leukemia
Bone Marrow
Pediatrics
Disease-Free Survival
Transplants
Busulfan
Survival
Confidence Intervals
Multivariate Analysis
Transplantation
Tissue Donors
Prospective Studies
Morbidity
Recurrence

Keywords

  • AML
  • Bone marrow transplant
  • Conditioning regimen
  • Pediatrics
  • Second CR

ASJC Scopus subject areas

  • Transplantation
  • Hematology

Cite this

Impact of Conditioning Regimen in Allogeneic Hematopoetic Stem Cell Transplantation for Children with Acute Myelogenous Leukemia beyond First Complete Remission : A Pediatric Blood and Marrow Transplant Consortium (PBMTC) Study. / Sisler, India Y.; Koehler, Elizabeth; Koyama, Tatsuki; Domm, Jennifer A.; Ryan, Robin; Levine, John E.; Pulsipher, Michael A.; Haut, Paul R.; Schultz, Kirk R.; Taylor, Douglas S.; Frangoul, Haydar A.

In: Biology of Blood and Marrow Transplantation, Vol. 15, No. 12, 12.2009, p. 1620-1627.

Research output: Contribution to journalArticle

Sisler, India Y. ; Koehler, Elizabeth ; Koyama, Tatsuki ; Domm, Jennifer A. ; Ryan, Robin ; Levine, John E. ; Pulsipher, Michael A. ; Haut, Paul R. ; Schultz, Kirk R. ; Taylor, Douglas S. ; Frangoul, Haydar A. / Impact of Conditioning Regimen in Allogeneic Hematopoetic Stem Cell Transplantation for Children with Acute Myelogenous Leukemia beyond First Complete Remission : A Pediatric Blood and Marrow Transplant Consortium (PBMTC) Study. In: Biology of Blood and Marrow Transplantation. 2009 ; Vol. 15, No. 12. pp. 1620-1627.
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abstract = "Total body irradiation (TBI)-based conditioning regimens for pediatric patients with acute myelogenous leukemia (AML) beyond first complete remission (CR1) are controversial. Because the long-term morbidity of busulfan (Bu)-based regimens appears to be lower, determining efficacy is critical. We retrospectively evaluated 151 pediatric patients with AML beyond CR1, comparing outcomes in 90 patients who received a TBI-based conditioning regimen and 61 patients who received a Bu-based conditioning regimen. There were no differences between the 2 groups with respect to age, sex, duration of CR1, time from most recent remission to transplantation, or donor source. The probability of relapse at 2 years also did not differ between the 2 groups (26{\%} and 27{\%}, respectively; P=.93). No significant difference in event-free survival (EFS) (P=.29) or overall survival (OS) (P=.11) was noted between the 2 groups. These findings were supported by a multivariate analysis in which TBI was not associated with improved EFS (hazard ratio [HR]=1.17; 95{\%} confidence interval [CI]=0.66-2.10; P=.58) or OS (HR=1.42; 95{\%} CI=0.76-2.64; P=.27). Shorter CR1 and receiving an HLA-mismatched transplant adversely affected EFS and OS in this cohort. Our study provides no evidence of an advantage to using TBI in children with AML beyond CR1. A prospective, randomized study is needed to confirm these results.",
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AU - Domm, Jennifer A.

AU - Ryan, Robin

AU - Levine, John E.

AU - Pulsipher, Michael A.

AU - Haut, Paul R.

AU - Schultz, Kirk R.

AU - Taylor, Douglas S.

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