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Thiotepa, busulfan and fludarabine conditioning-regimen is a promising approach for older adult patients with acute lymphoblastic leukemia treated with allogeneic stem cell transplantation

Bone Marrow Transplantation volume 58, pages 61–67 (2023)Cite this article

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Abstract

For acute lymphoblastic leukemia (ALL) patients, total body irradiation (TBI)- based conditioning regimens are the first choice specially in young population. However, several studies have shown an equivalence in clinical outcomes with thiotepa-based conditioning regimen. We performed a retrospective study to evaluate the outcome of adult ALL patients who received allogeneic hematopoietic stem cell transplantation (allo-HCT) with a thiotepa-busulfan-fludarabine (TBF) myeloablative conditioning regimen with reduced toxicity. Fifty-five patients received a TBF regimen. The median age of the patients was 51 years (range, 17 to 72.4). Most patients had a diagnosis of B-ALL (93%) with 7% having T-ALL. Two - and 5-year overall survival was 73.2% and 64%, respectively. At 2 years, leukemia-free survival and GVHD-free, relapse-free survival were 59.5% and 57.6%, and at 5 years, 53.4% and 51.8%, respectively. The 5-year non-relapse mortality was 15%. The day 180 cumulative incidence (CI) of grade II–IV acute GVHD and grade III–IV acute GVHD were 38.2% and 5.5%, respectively. At 2 years, the CI of chronic GVHD and extensive chronic GVHD was 16.9% and 1.9%, respectively. Our study results do suggest that using TBF as the conditioning regimen in adult ALL patients is a promising option with acceptable toxicity.

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Fig. 1: Long term outcomes after alloHSCT with conditioning regimen by TBF for ALL patients.
Fig. 2: Incidence and impact of GVHD in the cohort of patients with conditioning by TBF.

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Data availability

The data that support the findings of this study are available from the corresponding author, AB, upon reasonable request.

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Authors and Affiliations

  1. Sorbonne University, Paris, France

    Anne Banet, Myriam Labopin, Nicolas Stocker, Rémy Duléry, Florent Malard, Zoé Van de Wyngaert, Alexis Genthon, Mara Memoli, Ollivier Legrand, Agnes Bonnin, Tounes Ledraa, Ramdane Belhocine, Simona Sestili, Mohamad Mohty & Eolia Brissot

  2. Department of Clinical Hematology and Cellular Therapy, Saint-Antoine Hospital, AP-HP, Paris, France

    Anne Banet, Myriam Labopin, Nicolas Stocker, Rémy Duléry, Florent Malard, Zoé Van de Wyngaert, Alexis Genthon, Mara Memoli, Ollivier Legrand, Agnes Bonnin, Tounes Ledraa, Ramdane Belhocine, Simona Sestili, Mohamad Mohty & Eolia Brissot

  3. INSERM UMRs 938, Saint-Antoine Research Centre, Paris, France

    Anne Banet, Myriam Labopin, Nicolas Stocker, Rémy Duléry, Florent Malard, Zoé Van de Wyngaert, Alexis Genthon, Mara Memoli, Ollivier Legrand, Agnes Bonnin, Tounes Ledraa, Ramdane Belhocine, Simona Sestili, Mohamad Mohty & Eolia Brissot

  4. BMT program, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon

    Ali Bazarbachi & Jean El-Cheikh

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Contributions

AB and EB designed the study; ML performed the statistical analyses; AB wrote the manuscript; EB, AA and MM revised the manuscript, and all authors reviewed the final version of the manuscript.

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Correspondence to Anne Banet.

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Banet, A., Bazarbachi, A., Labopin, M. et al. Thiotepa, busulfan and fludarabine conditioning-regimen is a promising approach for older adult patients with acute lymphoblastic leukemia treated with allogeneic stem cell transplantation. Bone Marrow Transplant 58, 61–67 (2023). https://doi.org/10.1038/s41409-022-01841-0

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