A MULTICENTER, RETROSPECTIVE STUDY TO EVALUATE EFFICACY AND SAFETY OF BUSULFAN/FLUDARABINE CONDITIONING FOR ALLOGENEIC STEM CELL TRANSPLANTATION IN ADULT PATIENTS WITH ACUTE LYMPHOBLASTIC LEUKEMIA
Author(s): ,
Seung-Shin Lee
Affiliations:
Department of Hematology and Oncology,Wonkwang University Hospital,Iksan,Korea, Republic Of
,
Sung-Hoon Jung
Affiliations:
Department of Hematology and Oncology,Chonnam National University Hwasun Hospital,Hwasun,Korea, Republic Of
,
Mi Hwa Heo
Affiliations:
Department of Hematology and Oncology,Keimyung University Hospital,Dae-gu,Korea, Republic Of
,
Dae Sik Kim
Affiliations:
Department of Hematology and Oncology,Korea University Guro Hospital,Seoul,Korea, Republic Of
,
Ji Hyun Lee
Affiliations:
Department of Hematology and Oncology,Dong-A University Hospital,Busan,Korea, Republic Of
,
Han-Seung Park
Affiliations:
Department of Hematology,Asan Medical Center,Seoul,Korea, Republic Of
,
Yoo Jin Lee
Affiliations:
Department of Hematology and Oncology,Kyungpook National University Hospital,Dae-gu,Korea, Republic Of
,
Jun Ho Yi
Affiliations:
Department of Hematology and Oncology,Chung-Ang University Hospital,Seoul,Korea, Republic Of
,
Ka-won Kang
Affiliations:
Department of Hematology and Oncology,Korea University Anam Hospital,Seoul,Korea, Republic Of
,
Youngil Koh
Affiliations:
Department of Hematology and Oncology,Seoul National University Hospital,Seoul,Korea, Republic Of
,
Ho-Young Yhim
Affiliations:
Department of Hematology and Oncology,Chonbuk National University Hospital,Jeon-ju,Korea, Republic Of
,
Jae-Cheol Jo
Affiliations:
Department of Hematology and Oncology,Ulsan University Hospital,Ulsan,Korea, Republic Of
,
Yeung-Chul Mun
Affiliations:
Department of Hematology and Oncology,Ewha Womans University School of Medicine,Seoul,Korea, Republic Of
,
Won-Sik Lee
Affiliations:
Department of Hematology and Oncology,Inje University Busan Paik Hospital,Busan,Korea, Republic Of
,
Deok-Hwan Yang
Affiliations:
Department of Hematology and Oncology,Chonnam National University Hwasun Hospital,Hwasun,Korea, Republic Of
Seok Lee
Affiliations:
Department of Hematology,Seoul St. Mary's Hospital,Seoul,Korea, Republic Of
EHA Library. Lee S. Jun 15, 2019; 267257; PS956
Dr. Seung-Shin Lee
Dr. Seung-Shin Lee
Contributions
Abstract

Abstract: PS956

Type: Poster Presentation

Presentation during EHA24: On Saturday, June 15, 2019 from 17:30 - 19:00

Location: Poster area

Background
Although the complete remission rate of adult acute lymphoblastic leukemia(ALL) are more than 80% with intensive combination chemotherapy, but nearly one half relapse eventually. Patients with relapsed ALL have very poor prognosis with 5-year survival around 7%. Therefore, optimal use of high dose chemotherapy and allogeneic stem cell transplantation in remission state have been a standard approach.

Aims
Conditioning incorporating total body irradiation have been replaced by regimens including busulfan combined with various agents because of its toxicity. The purpose of this retrospective study is to evaluate efficacy and safety of busulfan/fludarabine regimen for allogeneic stem cell transplantation in adult patients with acute lymphoblastic leukemia.

Methods
We conducted a retrospective cohort study using data from 112 patients who had allogeneic stem cell transplantation with conditioning regimen of busulfan and fludarabine in 13 centers in Korea between 2007 and 2018. Myeloablative conditioning was defined as regimens with 4 days or more of busulfan (3.2mg/kg/day) combined with fludarabine. Survival outcomes and incidence of complications of transplantation were evaluated.

Results
A total of 112 patients was included in this study. The median age was 45 years (range, 17 to 64 years). More than 95 percent of patients underwent transplantations in complete remission. Myeloablative conditioning was used in 31(27.7%) among all patients and in 7(16.3%) among patients of aged 50 or more. With median follow-up of 22 months (range, 1.2 to 71.2) among survivors, 2-year overall survival and relapse-free survival was 57% and 44%, respectively. In multivariate analysis, factors significantly associated with overall survival were the use of reduced-intensity conditioning (HR 0.43 ; p<0.01) and disease status at transplantation. (HR 8.83; P<0.01 for non-remission state compared with remission state). There was no difference in PFS according to conditioning intensity. This regimen was well tolerated with nonrelapse mortality of 10% at 6 months and 19% at 2 years post-transplantation. The incidence of hepatic veno-occlusive disease was 2(1.8%) without fatality. The cumulative incidence of relapse, acute GVHD, and chronic GVHD was 50%, 36% and 30%, respectively.

Conclusion
Conditioning using busulfan and fludarabine had an acceptable efficacy and tolerability.

Session topic: 2. Acute lymphoblastic leukemia - Clinical

Keyword(s): Allogeneic hematopoietic stem cell transplant, Busulfan, Fludarabine

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