Pharmacokinetically-targeted BU and fludarabine as conditioning before allogeneic hematopoietic cell transplantation for adults with ALL in first remission

G. Kunter, J. B. Perkins, J. Pidala, T. Nishihori, M. A. Kharfan-Dabaja, T. Field, H. Fernandez, L. Perez, F. Locke, E. Ayala, M. Tomblyn, J. L. Ochoa-Bayona, Brian Betts, M. Nieder, C. Anasetti

Research output: Contribution to journalArticlepeer-review

9 Scopus citations

Abstract

Allogeneic hematopoietic cell transplantation offers improved survival in patients with ALL, but with regimens containing TBI, the nonrelapse mortality is 20-40%. Efforts to lessen transplant toxicities by reducing conditioning regimen intensity have led to increased relapse risk. Therefore, there is a need for less toxic regimens that maintain an anti-leukemia effect. We report here a retrospective review of 65 patients with ALL in first remission receiving grafts from allogeneic donors after fludarabine 40 mg/m 2 /day for 4 days and i.v. BU targeted to a median daily area under the concentration-time curve below 6000 μmoles min/L. At 2 years after transplantation, OS was 65% (95% confidence interval (CI): 52-77%), relapse-free survival was 61% (95% CI: 48-73%), cumulative incidence of relapse was 26% (95% CI: 17-39%) and cumulative incidence of nonrelapse mortality was 14% (95% CI: 8-26%). Age over 35 years, Ph chromosome positivity and minimal residual disease at transplant did not adversely affect outcomes. Pharmacokinetically targeted BU and fludarabine can provide intensive pre-transplant conditioning for adults with ALL in first remission, with promising relapse-free and OS rates.

Original languageEnglish (US)
Pages (from-to)11-16
Number of pages6
JournalBone Marrow Transplantation
Volume49
Issue number1
DOIs
StatePublished - Jan 1 2014
Externally publishedYes

Keywords

  • ALL
  • Adult
  • BU
  • Fludarabine
  • Pharmacokinetics

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