• Seung Shin Lee, Sung Hoon Jung, Young Rok Do, Dae Sik Kim, Ji Hyun Lee, Han Seung Park, Joon Ho Moon, Jun Ho Yi, Yong Park, Youngil Koh, Ho Young Yhim, Yunsuk Choi, Yeung Chul Mun, Won Sik Lee, Seok Lee, Deok Hwan Yang, and Korean Adult Acute Lymphoblastic Leukemia Working Party.
• Department of Hematology and Oncology, Wonkwang University Hospital, Iksan, Korea.
• Yonsei Med. J. 2020 Jun 1; 61 (6): 452-459.

PurposeAllogeneic hematopoietic stem cell transplantation (HSCT) with optimal conditioning has helped better long-term survival in acute lymphoblastic leukemia (ALL). This study investigated the efficacy and safety of reduced-intensity conditioning (RIC) with busulfan and fludarabine in adult ALL patients unfit for myeloablation.Materials And MethodsRecords of 78 patients who underwent HSCT with RIC consisting of 3.2 mg/kg/day of busulfan for 2 or 3 days and 30 mg/m²/day of fludarabine for 5 or 6 days were analyzed.ResultsThe median age at diagnosis was 49 years. Over a median follow-up of 22 months, 2-year estimates of relapse-free survival (RFS) and overall survival were 57.4% and 68.7%, respectively. Multivariate analysis showed a trend of improved RFS in patients with chronic graft-versus-host disease (GVHD) (hazard ratio, 0.53; 95% confidence interval, 0.26-1.08; p=0.080). The cumulative incidences of relapse and non-relapse mortality were 42.9% and 19.6%, respectively and one case of central nervous system relapse was noted. No hepatic veno-occlusive disease was reported. Grade II-IV acute GVHD and any grade chronic GVHD occurred in 21.1% and 41.7%, respectively.ConclusionRIC with busulfan and fludarabine is an effective and safe conditioning regimen for adult ALL patients unfit for myeloablation.© Copyright: Yonsei University College of Medicine 2020.

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