TY - JOUR
T1 - Impact of conditioning intensity and regimen on transplant outcomes in patients with adult T-cell leukemia-lymphoma
AU - ATL Working Group of the Japan Society for Hematopoietic Cell Transplantation
AU - Inoue, Yoshitaka
AU - Nakano, Nobuaki
AU - Fuji, Shigeo
AU - Eto, Tetsuya
AU - Kawakita, Toshiro
AU - Suehiro, Youko
AU - Miyamoto, Toshihiro
AU - Sawayama, Yasushi
AU - Uchida, Naoyuki
AU - Kondo, Tadakazu
AU - Kanda, Junya
AU - Atsuta, Yoshiko
AU - Fukuda, Takahiro
AU - Yoshimitsu, Makoto
AU - Kato, Koji
N1 - Funding Information:
This research was supported by the Practical Research for Innovative Cancer Control Program of the Japan Agency for Medical Research and Development (20ck0106616h0001) and by JSPS KAKENHI Grant Number 19K17861. We are grateful to the ATL Working Group of the Japan Society for Hematopoietic Cell Transplantation and the Japanese Data Center for Hematopoietic Cell Transplantation for helping with this study.
Funding Information:
NN: honoraria (e.g., lecture fees) from Otsuka Pharmaceutical. SF: honoraria from Kyowa Kirin. NU: honoraria from Otsuka Pharmaceutical. TK: honoraria from Otsuka Pharmaceutical. JK: honoraria from Sanofi and Otsuka Pharmaceutical. KK: consulting fees from AbbVie, AstraZeneca, Celgene, Chugai, Eisai, Janssen, Novartis, and Daiichi Sankyo; honoraria from Takeda, MSD, Kyowa-Kirin, Janssen, Celgene, Ono, Mundi, Dainippon-Sumitomo, and Bristol-Myers Squibb; research funding from Chugai, Takeda, Kyowa Kirin, AbbVie, Novartis, Eisai, Janssen, Celgene, Ono, Novartis, and Daiichi Sankyo. The other authors declare no conflicts of interest associated with this manuscript.
Publisher Copyright:
© 2021, The Author(s), under exclusive licence to Springer Nature Limited.
PY - 2021/12
Y1 - 2021/12
N2 - In allogeneic hematopoietic cell transplantation (allo-HCT) for adult T-cell leukemia-lymphoma (ATL), the optimal conditioning regimens have not yet been determined. We conducted a Japanese nationwide, retrospective study to investigate this issue. This study included 914 ATL patients who underwent allo-HCT between 1995 and 2015. In patients aged 55 years or younger, there was no statistically significant difference between reduced-intensity conditioning (RIC) regimens and myeloablative conditioning (MAC) regimens regarding risk of relapse (vs. RIC group: MAC group, hazard ratio (HR) 0.76, P = 0.071), non-relapse mortality (vs. RIC group: MAC group, HR 1.38, P = 0.115), or overall mortality (vs. RIC group: MAC group, HR 1.17, P = 0.255). Among RIC regimens, fludarabine plus melphalan-based (Flu/Mel) regimens were associated with a lower risk of relapse (Flu/Mel140 group, HR 0.59, P < 0.001; Flu/Mel80 group, HR 0.79, P = 0.021) than the Flu plus busulfan-based regimen (Flu/Bu2 group). Meanwhile, Flu/Mel140 group had a significantly higher risk of non-relapse mortality (vs. Flu/Bu2 group: HR 1.53, P = 0.025). In conclusion, it is acceptable to select a RIC regimen for younger patients. Moreover, it might be beneficial to select a Flu/Mel-based regimen for patients at high risk of relapse.
AB - In allogeneic hematopoietic cell transplantation (allo-HCT) for adult T-cell leukemia-lymphoma (ATL), the optimal conditioning regimens have not yet been determined. We conducted a Japanese nationwide, retrospective study to investigate this issue. This study included 914 ATL patients who underwent allo-HCT between 1995 and 2015. In patients aged 55 years or younger, there was no statistically significant difference between reduced-intensity conditioning (RIC) regimens and myeloablative conditioning (MAC) regimens regarding risk of relapse (vs. RIC group: MAC group, hazard ratio (HR) 0.76, P = 0.071), non-relapse mortality (vs. RIC group: MAC group, HR 1.38, P = 0.115), or overall mortality (vs. RIC group: MAC group, HR 1.17, P = 0.255). Among RIC regimens, fludarabine plus melphalan-based (Flu/Mel) regimens were associated with a lower risk of relapse (Flu/Mel140 group, HR 0.59, P < 0.001; Flu/Mel80 group, HR 0.79, P = 0.021) than the Flu plus busulfan-based regimen (Flu/Bu2 group). Meanwhile, Flu/Mel140 group had a significantly higher risk of non-relapse mortality (vs. Flu/Bu2 group: HR 1.53, P = 0.025). In conclusion, it is acceptable to select a RIC regimen for younger patients. Moreover, it might be beneficial to select a Flu/Mel-based regimen for patients at high risk of relapse.
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U2 - 10.1038/s41409-021-01445-0
DO - 10.1038/s41409-021-01445-0
M3 - Article
C2 - 34462567
AN - SCOPUS:85114026607
VL - 56
SP - 2964
EP - 2974
JO - Bone Marrow Transplantation
JF - Bone Marrow Transplantation
SN - 0268-3369
IS - 12
ER -