• Hiroyuki Ishida, Souichi Adachi, Daiichiro Hasegawa, Yasuhiro Okamoto, Hiroaki Goto, Jiro Inagaki, Masami Inoue, Katsuyoshi Koh, Hiromasa Yabe, Keisei Kawa, Koji Kato, Yoshiko Atsuta, and Kazuko Kudo.
• Department of Pediatrics, Kyoto Prefectural University of Medicine, Kyoto, Japan; Division of Pediatrics, Matsushita Memorial Hospital, Moriguchi, Japan.
• Pediatr Blood Cancer. 2015 May 1; 62 (5): 883-9.

BackgroundThe relative efficacy of allogeneic hematopoietic cell transplantation (allo-HCT) after reduced toxicity conditioning (RTC) compared with standard myeloablative conditioning (MAC) in pediatric patients with acute myeloid leukemia (AML) has not been studied extensively. To address whether RTC is a feasible approach for pediatric patients with AML in remission, we performed a retrospective investigation of the outcomes of the first transplant in patients who had received an allo-HCT after RTC or standard MAC, using nationwide registration data collected between 2000 and 2011 in Japan.ProcedureWe compared a fludarabine (Flu) and melphalan (Mel)-based regimen (RTC; n = 34) with total body irradiation (TBI) and/or busulfan (Bu)-based conditioning (MAC; n = 102) in demographic- and disease-criteria-matched childhood and adolescent patients with AML in first or second complete remission (CR1/CR2).ResultsThe incidence of engraftment, early complications, grade II-IV acute graft-versus-host disease (GVHD), and chronic GVHD were similar in each conditioning group. The risk of relapse (25% vs. 26%) and non-relapse mortality (13% vs. 11%) after 3 years did not differ between these groups, and univariate and multivariate analyses demonstrated that the 3-year overall survival (OS) rates after Flu/Mel-RTC and MAC were comparable (mean, 72% [range, 51-85%] and 68% [range, 58-77%], respectively).ConclusionsThe results suggest that the Flu/Mel-RTC regimen is a clinically acceptable conditioning strategy for childhood and adolescent patients with AML in remission. Although this retrospective, registry-based analysis has several limitations, RTC deserves to be further investigated in prospective trials.© 2014 Wiley Periodicals, Inc.

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