Comparison of Outcomes for Pediatric Patients With Acute Myeloid Leukemia in Remission and Undergoing Allogeneic Hematopoietic Cell Transplantation With Myeloablative Conditioning Regimens Based on Either Intravenous Busulfan or Total Body Irradiation: A Report From the Japanese Society for Hematopoietic Cell Transplantation

Hiroyuki Ishida, Motohiro Kato, Kazuko Kudo, Takashi Taga, Daisuke Tomizawa, Takako Miyamura, Hiroaki Goto, Jiro Inagaki, Katsuyoshi Koh, Kiminori Terui, Atsushi Ogawa, Yoshifumi Kawano, Masami Inoue, Akihisa Sawada, Koji Kato, Yoshiko Atsuta, Takuya Yamashita, Souichi Adachi

Research output: Contribution to journalArticle

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Abstract

Pediatric patients with acute myeloid leukemia (AML) mainly receive myeloablative conditioning regimens based on busulfan (BU) or total body irradiation (TBI) before allogeneic hematopoietic cell transplantation (allo-HCT); however, the optimal conditioning regimen remains unclear. To identify which of these regimens is better for pediatric patients, we performed a retrospective analysis of nationwide registration data collected in Japan between 2006 and 2011 to assess the outcomes of patients receiving these regimens before a first allo-HCT. Myeloablative conditioning regimens based on i.v. BU (i.v. BU-MAC) (n = 69) or TBI (TBI-MAC) (n = 151) were compared in pediatric AML patients in first or second complete remission (CR1/CR2). The incidences of sinusoid obstruction syndrome, acute and chronic graft-versus-host disease, and early nonrelapse mortality (NRM) before day 100 were similar for both conditioning groups; however, the incidence of bacterial infection during the acute period was higher in the TBI-MAC group (. P = .008). Both groups showed a similar incidence of NRM, and there was no significant difference in the incidence of relapse between the groups. Univariate and multivariate analyses revealed no significant differences in the 2-year relapse-free survival rates for the i.v. BU-MAC and TBI-MAC groups in the CR1/CR2 setting (71% versus 67%, P = .36; hazard ratio, .73; 95% CI, .43 to 1.24, respectively). TBI-MAC was no better than i.v. BU-MAC for pediatric AML patients in remission. Although this retrospective registry-based analysis has several limitations, i.v. BU-MAC warrants further evaluation in a prospective trial.

Original languageEnglish
Pages (from-to)2141-2147
Number of pages7
JournalBiology of Blood and Marrow Transplantation
Volume21
Issue number12
DOIs
Publication statusPublished - Dec 2015
Externally publishedYes

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Busulfan
Whole-Body Irradiation
Cell Transplantation
Acute Myeloid Leukemia
Pediatrics
Incidence
Recurrence
Mortality
Graft vs Host Disease
Bacterial Infections
Registries
Japan
Multivariate Analysis
Survival Rate

All Science Journal Classification (ASJC) codes

  • Hematology
  • Transplantation

Cite this

Comparison of Outcomes for Pediatric Patients With Acute Myeloid Leukemia in Remission and Undergoing Allogeneic Hematopoietic Cell Transplantation With Myeloablative Conditioning Regimens Based on Either Intravenous Busulfan or Total Body Irradiation : A Report From the Japanese Society for Hematopoietic Cell Transplantation. / Ishida, Hiroyuki; Kato, Motohiro; Kudo, Kazuko; Taga, Takashi; Tomizawa, Daisuke; Miyamura, Takako; Goto, Hiroaki; Inagaki, Jiro; Koh, Katsuyoshi; Terui, Kiminori; Ogawa, Atsushi; Kawano, Yoshifumi; Inoue, Masami; Sawada, Akihisa; Kato, Koji; Atsuta, Yoshiko; Yamashita, Takuya; Adachi, Souichi.

In: Biology of Blood and Marrow Transplantation, Vol. 21, No. 12, 12.2015, p. 2141-2147.

Research output: Contribution to journalArticle

Ishida, Hiroyuki ; Kato, Motohiro ; Kudo, Kazuko ; Taga, Takashi ; Tomizawa, Daisuke ; Miyamura, Takako ; Goto, Hiroaki ; Inagaki, Jiro ; Koh, Katsuyoshi ; Terui, Kiminori ; Ogawa, Atsushi ; Kawano, Yoshifumi ; Inoue, Masami ; Sawada, Akihisa ; Kato, Koji ; Atsuta, Yoshiko ; Yamashita, Takuya ; Adachi, Souichi. / Comparison of Outcomes for Pediatric Patients With Acute Myeloid Leukemia in Remission and Undergoing Allogeneic Hematopoietic Cell Transplantation With Myeloablative Conditioning Regimens Based on Either Intravenous Busulfan or Total Body Irradiation : A Report From the Japanese Society for Hematopoietic Cell Transplantation. In: Biology of Blood and Marrow Transplantation. 2015 ; Vol. 21, No. 12. pp. 2141-2147.
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abstract = "Pediatric patients with acute myeloid leukemia (AML) mainly receive myeloablative conditioning regimens based on busulfan (BU) or total body irradiation (TBI) before allogeneic hematopoietic cell transplantation (allo-HCT); however, the optimal conditioning regimen remains unclear. To identify which of these regimens is better for pediatric patients, we performed a retrospective analysis of nationwide registration data collected in Japan between 2006 and 2011 to assess the outcomes of patients receiving these regimens before a first allo-HCT. Myeloablative conditioning regimens based on i.v. BU (i.v. BU-MAC) (n = 69) or TBI (TBI-MAC) (n = 151) were compared in pediatric AML patients in first or second complete remission (CR1/CR2). The incidences of sinusoid obstruction syndrome, acute and chronic graft-versus-host disease, and early nonrelapse mortality (NRM) before day 100 were similar for both conditioning groups; however, the incidence of bacterial infection during the acute period was higher in the TBI-MAC group (. P = .008). Both groups showed a similar incidence of NRM, and there was no significant difference in the incidence of relapse between the groups. Univariate and multivariate analyses revealed no significant differences in the 2-year relapse-free survival rates for the i.v. BU-MAC and TBI-MAC groups in the CR1/CR2 setting (71{\%} versus 67{\%}, P = .36; hazard ratio, .73; 95{\%} CI, .43 to 1.24, respectively). TBI-MAC was no better than i.v. BU-MAC for pediatric AML patients in remission. Although this retrospective registry-based analysis has several limitations, i.v. BU-MAC warrants further evaluation in a prospective trial.",
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AU - Taga, Takashi

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AU - Miyamura, Takako

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AU - Koh, Katsuyoshi

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AU - Kawano, Yoshifumi

AU - Inoue, Masami

AU - Sawada, Akihisa

AU - Kato, Koji

AU - Atsuta, Yoshiko

AU - Yamashita, Takuya

AU - Adachi, Souichi

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