TY - JOUR
T1 - The Sequence of Cyclophosphamide and Myeloablative Total Body Irradiation in Hematopoietic Cell Transplantation for Patients with Acute Leukemia
AU - Holter-Chakrabarty, Jennifer L.
AU - Pierson, Namali
AU - Zhang, Mei Jie
AU - Zhu, Xiaochun
AU - Akpek, Görgün
AU - Aljurf, Mahmoud D.
AU - Artz, Andrew S.
AU - Baron, Frédéric
AU - Bredeson, Christopher N.
AU - Dvorak, Christopher C.
AU - Epstein, Robert B.
AU - Lazarus, Hillard M.
AU - Olsson, Richard F.
AU - Selby, George B.
AU - Williams, Kirsten M.
AU - Cooke, Kenneth R.
AU - Pasquini, Marcelo C.
AU - McCarthy, Philip L.
N1 - Funding Information:
The CIBMTR is supported by Public Health Service grant/cooperative agreement U24-CA076518 from the National Cancer Institute (NCI), the National Heart, Lung, and Blood Institute (NHLBI) and the National Institute of Allergy and Infectious Diseases (NIAID); a grant/cooperative agreement 5U10HL069294 from NHLBI and NCI ; a contract HHSH250201200016C with Health Resources and Services Administration (HRSA/DHHS); 2 Grants N00014-12-1-0142 and N00014-13-1-0039 from the Office of Naval Research ; and grants from * Actinium Pharmaceuticals ; Allos Therapeutics, Inc. ; * Amgen ; anonymous donation to the Medical College of Wisconsin; Ariad; Be the Match Foundation; * Blue Cross and Blue Shield Association ; * Celgene Corporation ; Chimerix, Inc. ; Fred Hutchinson Cancer Research Center ; Fresenius-Biotech North America, Inc. ; * Gamida Cell Teva Joint Venture Ltd. ; Genentech, Inc. ; * Gentium SpA ; Genzyme Corporation ; GlaxoSmithKline ; Health Research, Inc. Roswell Park Cancer Institute; HistoGenetics ; Incyte Corporation ; Jeff Gordon Children's Foundation ; Kiadis Pharma ; The Leukemia & Lymphoma Society ; Medac GmbH ; The Medical College of Wisconsin ; Merck & Co., Inc. ; Millennium: The Takeda Oncology Co. ; * Milliman USA, Inc. ; * Miltenyi Biotec ; National Marrow Donor Program; Onyx Pharmaceuticals ; Optum Healthcare Solutions, Inc. ; Osiris Therapeutics ; Otsuka America Pharmaceutical, Inc. ; Perkin Elmer, Inc. ; * Remedy Informatics ; * Sanofi US ; Seattle Genetics ; Sigma-Tau Pharmaceuticals ; Soligenix, Inc. ; St. Baldrick's Foundation ; StemCyte , A Global Cord Blood Therapeutics Co.; Stemsoft Software, Inc. ; Swedish Orphan Biovitrum ; * Tarix Pharmaceuticals ; * Terumo BCT ; * Teva Neuroscience, Inc. ; * Therakos ; University of Minnesota ; University of Utah ; and * WellPoint . The views expressed in this article do not reflect the official policy or position of the National Institute of Health, the Department of the Navy, the Department of Defense, Health Resources and Services Administration or any other agency of the US Government.
Publisher Copyright:
© 2015 American Society for Blood and Marrow Transplantation.
PY - 2015/7/1
Y1 - 2015/7/1
N2 - Limited clinical data are available to assess whether the sequencing of cyclophosphamide (Cy) and total body irradiation (TBI) changes outcomes. We evaluated the sequence in 1769 (CyTBI, n= 948; TBICy, n= 821) recipients of related or unrelated hematopoietic cell transplantation who received TBI (1200 to 1500 cGY) for acute leukemia from 2003 to 2010. The 2 cohorts were comparable for median age, performance score, type of leukemia, first complete remission, Philadelphia chromosome-positive acute lymphoblastic leukemia, HLA-matched siblings, stem cell source, antithymocyte globulin use, TBI dose, and type of graft-versus-host disease (GVHD) prophylaxis. The sequence of TBI did not significantly affect transplantation-related mortality (24% versus 23% at 3 years, P= .67; relative risk, 1.01; P= .91), leukemia relapse (27% versus 29% at 3 years, P= .34; relative risk, .89, P= .18), leukemia-free survival (49% versus 48% at 3 years, P= .27; relative risk, .93; P= .29), chronic GVHD (45% versus 47% at 1 year, P= .39; relative risk, .9; P= .11), or overall survival (53% versus 52% at 3 years, P= .62; relative risk, .96; P= .57) for CyTBI and TBICy, respectively. Corresponding cumulative incidences of sinusoidal obstruction syndrome were 4% and 6% at 100 days (P= .08), respectively. This study demonstrates that the sequence of Cy and TBI does not impact transplantation outcomes and complications in patients with acute leukemia undergoing hematopoietic cell transplantation with myeloablative conditioning.
AB - Limited clinical data are available to assess whether the sequencing of cyclophosphamide (Cy) and total body irradiation (TBI) changes outcomes. We evaluated the sequence in 1769 (CyTBI, n= 948; TBICy, n= 821) recipients of related or unrelated hematopoietic cell transplantation who received TBI (1200 to 1500 cGY) for acute leukemia from 2003 to 2010. The 2 cohorts were comparable for median age, performance score, type of leukemia, first complete remission, Philadelphia chromosome-positive acute lymphoblastic leukemia, HLA-matched siblings, stem cell source, antithymocyte globulin use, TBI dose, and type of graft-versus-host disease (GVHD) prophylaxis. The sequence of TBI did not significantly affect transplantation-related mortality (24% versus 23% at 3 years, P= .67; relative risk, 1.01; P= .91), leukemia relapse (27% versus 29% at 3 years, P= .34; relative risk, .89, P= .18), leukemia-free survival (49% versus 48% at 3 years, P= .27; relative risk, .93; P= .29), chronic GVHD (45% versus 47% at 1 year, P= .39; relative risk, .9; P= .11), or overall survival (53% versus 52% at 3 years, P= .62; relative risk, .96; P= .57) for CyTBI and TBICy, respectively. Corresponding cumulative incidences of sinusoidal obstruction syndrome were 4% and 6% at 100 days (P= .08), respectively. This study demonstrates that the sequence of Cy and TBI does not impact transplantation outcomes and complications in patients with acute leukemia undergoing hematopoietic cell transplantation with myeloablative conditioning.
KW - Allogeneic transplantation
KW - Leukemia
KW - Total body irradiation
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U2 - 10.1016/j.bbmt.2015.03.017
DO - 10.1016/j.bbmt.2015.03.017
M3 - Article
C2 - 25840335
AN - SCOPUS:84930576712
VL - 21
SP - 1251
EP - 1257
JO - Biology of Blood and Marrow Transplantation
JF - Biology of Blood and Marrow Transplantation
SN - 1083-8791
IS - 7
ER -