• 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, and Souichi Adachi.
• Department of Pediatrics and Blood and Marrow Transplantation, Matsushita Memorial Hospital, Moriguchi, Japan; Department of Pediatrics, Kyoto Prefectural University of Medicine, Kyoto, Japan. Electronic address: ishidah@koto.kpu-m.ac.jp.
• Biol. Blood Marrow Transplant. 2015 Dec 1; 21 (12): 2141-2147.

AbstractPediatric 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.Copyright © 2015 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.

39 keywords...

hide…