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Conditioning Regimens

Pharmacokinetically-targeted BU and fludarabine as conditioning before allogeneic hematopoietic cell transplantation for adults with ALL in first remission

Bone Marrow Transplantation volume 49, pages 11–16 (2014)Cite this article

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Abstract

Allogeneic hematopoietic cell transplantation offers improved survival in patients with ALL, but with regimens containing TBI, the nonrelapse mortality is 20–40%. Efforts to lessen transplant toxicities by reducing conditioning regimen intensity have led to increased relapse risk. Therefore, there is a need for less toxic regimens that maintain an anti-leukemia effect. We report here a retrospective review of 65 patients with ALL in first remission receiving grafts from allogeneic donors after fludarabine 40 mg/m2/day for 4 days and i.v. BU targeted to a median daily area under the concentration–time curve below 6000 μmoles min/L. At 2 years after transplantation, OS was 65% (95% confidence interval (CI): 52–77%), relapse-free survival was 61% (95% CI: 48–73%), cumulative incidence of relapse was 26% (95% CI: 17–39%) and cumulative incidence of nonrelapse mortality was 14% (95% CI: 8–26%). Age over 35 years, Ph chromosome positivity and minimal residual disease at transplant did not adversely affect outcomes. Pharmacokinetically targeted BU and fludarabine can provide intensive pre-transplant conditioning for adults with ALL in first remission, with promising relapse-free and OS rates.

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Author notes

  1. G Kunter and J B Perkins: These authors contributed equally to this work.

Authors and Affiliations

  1. Department of Blood and Marrow Transplantation, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA

    G Kunter, J B Perkins, J Pidala, T Nishihori, M A Kharfan-Dabaja, T Field, H Fernandez, L Perez, F Locke, E Ayala, M Tomblyn, J L Ochoa-Bayona, B Betts, M Nieder & C Anasetti

  2. Oncologic Sciences, University of South Florida, Tampa, FL, USA

    G Kunter, J B Perkins, J Pidala, T Nishihori, M A Kharfan-Dabaja, T Field, H Fernandez, L Perez, F Locke, E Ayala, M Tomblyn, J L Ochoa-Bayona, B Betts, M Nieder & C Anasetti

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Correspondence to C Anasetti.

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Additional information

The study abstract was presented in oral session at the Meeting of the American Society of Hematology, December 10-13, 2011, San Diego, California.

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Kunter, G., Perkins, J., Pidala, J. et al. Pharmacokinetically-targeted BU and fludarabine as conditioning before allogeneic hematopoietic cell transplantation for adults with ALL in first remission. Bone Marrow Transplant 49, 11–16 (2014). https://doi.org/10.1038/bmt.2013.121

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