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Willasch, A.M.; Peters, C.; Sedlacek, P.; Dalle, J.H.; Kitra-Roussou, V.; Yesilipek, A.; ... ; EBMT Paediat Dis Working Party (2020)

Myeloablative conditioning for allo-HSCT in pediatric ALL: FTBI or chemotherapy?-A multicenter EBMT-PDWP study

Article / Letter to editor
Although most children with acute lymphoblastic leukemia (ALL) receive fractionated total body irradiation (FTBI) as myeloablative conditioning (MAC) for allogeneic hematopoietic stem cell transplantation (allo-HSCT), it is an important matter of debate if chemotherapy can effectively replace FTBI. To compare outcomes after FTBI versus chemotherapy-based conditioning (CC), we performed a retrospective EBMT registry study. Children aged 2-18 years after MAC for first allo-HSCT of bone marrow (BM) or peripheral blood stem cells (PBSC) from matched-related (MRD) or unrelated donors (UD) in first (CR1) or second remission (CR2) between 2000 and 2012 were included. Propensity score weighting was used to control pretreatment imbalances of the observed variables. 3.054 patients were analyzed. CR1 (1.498): median follow-up (FU) after FTBI (1.285) and CC (213) was 6.8 and 6.1 years. Survivals were not significantly different. CR2 (1.556): median FU after FTBI (1.345) and CC (211) was 6.2...Show moreAlthough most children with acute lymphoblastic leukemia (ALL) receive fractionated total body irradiation (FTBI) as myeloablative conditioning (MAC) for allogeneic hematopoietic stem cell transplantation (allo-HSCT), it is an important matter of debate if chemotherapy can effectively replace FTBI. To compare outcomes after FTBI versus chemotherapy-based conditioning (CC), we performed a retrospective EBMT registry study. Children aged 2-18 years after MAC for first allo-HSCT of bone marrow (BM) or peripheral blood stem cells (PBSC) from matched-related (MRD) or unrelated donors (UD) in first (CR1) or second remission (CR2) between 2000 and 2012 were included. Propensity score weighting was used to control pretreatment imbalances of the observed variables. 3.054 patients were analyzed. CR1 (1.498): median follow-up (FU) after FTBI (1.285) and CC (213) was 6.8 and 6.1 years. Survivals were not significantly different. CR2 (1.556): median FU after FTBI (1.345) and CC (211) was 6.2 years. Outcomes after FTBI were superior as compared with CC with regard to overall survival (OS), leukemia-free survival (LFS), relapse incidence (RI), and nonrelapse mortality (NRM). However, we must emphasize the preliminary character of the results of this retrospective "real-world-practice" study. These findings will be prospectively assessed in the ALL SCTped 2012 FORUM trial.Show less
All authors
Willasch, A.M.; Peters, C.; Sedlacek, P.; Dalle, J.H.; Kitra-Roussou, V.; Yesilipek, A.; Wachowiak, J.; Lankester, A.; Prete, A.; Hamidieh, A.A.; Ifversen, M.; Buechner, J.; Krivan, G.; Hamladji, R.M.; Diaz-de-Heredia, C.; Skorobogatova, E.; Michel, G.; Locatelli, F.; Bertaina, A.; Veys, P.; Dupont, S.; Or, R.; Gungor, T.; Aleinikova, O.; Sufliarska, S.; Sundin, M.; Rascon, J.; Kaare, A.; Nemet, D.; Fagioli, F.; Klingebiel, T.E.; Styczynski, J.; Bierings, M.; Nagy, K.; Abecasis, M.; Afanasyev, B.; Ansari, M.; Vettenranta, K.; Alseraihy, A.; Chybicka, A.; Robinson, S.; Bertrand, Y.; Kupesiz, A.; Ghavamzadeh, A.; Campos, A.; Pichler, H.; Dalissier, A.; Labopin, M.; Corbacioglu, S.; Balduzzi, A.; Galimard, J.E.; Bader, P.; EBMT Paediat Dis Working Party
Date
2020-03-17
Journal
Bone Marrow Transplantation
Volume
55
Issue
8
Pages
1540 - 1551
DOI
doi:10.1038/s41409-020-0854-0
Link
https://www.nature.com/articles/s41409-020-0854-0