Comparison of Outcomes of Allogeneic Transplantation for Chronic Myeloid Leukemia with Cyclophosphamide in Combination with Intravenous Busulfan, Oral Busulfan, or Total Body Irradiation

Edward A. Copelan, Belinda R. Avalos, Kwang Woo Ahn, Xiaochun Zhu, Robert Peter Gale, Michael R. Grunwald, Mehdi Hamadani, Betty K. Hamilton, Gregory A. Hale, David I. Marks, Edmund K. Waller, Bipin N. Savani, Luciano J. Costa, Muthalagu Ramanathan, Jean Yves Cahn, H. Jean Khoury, Daniel J. Weisdorf, Yoshihiro Inamoto, Rammurti T. Kamble, Harry C. Schouten & 18 others Baldeep Wirk, Mark R Litzow, Mahmoud D. Aljurf, Koen W. van Besien, Celalettin Ustun, Brian J. Bolwell, Christopher N. Bredeson, Omotayo Fasan, Nilanjan Ghosh, Mary M. Horowitz, Mukta Arora, Jeffrey Szer, Alison W. Loren, Edwin P. Alyea, Jorge Cortes, Richard T. Maziarz, Matt E. Kalaycio, Wael Saber

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Cyclophosphamide (Cy) in combination with busulfan (Bu) or total body irradiation (TBI) is the most commonly used myeloablative conditioning regimen in patients with chronic myeloid leukemia (CML). We used data from the Center for International Bone Marrow Transplantation Research to compare outcomes in adults who underwent hematopoietic cell transplantation for CML in first chronic phase after myeloablative conditioning with Cy in combination with TBI, oral Bu, or intravenous (i.v.) Bu. Four hundred thirty-eight adults received human leukocyte antigen (HLA)-matched sibling grafts and 235 received well-matched grafts from unrelated donors (URD) from 2000 through 2006. Important differences existed between the groups in distribution of donor relation, exposure to tyrosine kinase inhibitors, and year of transplantation. In multivariate analysis, relapse occurred less frequently among patients receiving i.v. Bu compared with TBI (relative risk [RR], .36; P=022) or oral Bu (RR, .39; P=028), but nonrelapse mortality and survival were similar. A significant interaction was detected between donor relation and the main effect in leukemia-free survival (LFS). Among recipients of HLA-identical sibling grafts, but not URD grafts, LFS was better in patients receiving i.v. Bu (RR, .53; P=025) or oral Bu (RR, .64; P=017) compared with TBI. In CML in first chronic phase, Cy in combination with i.v. Bu was associated with less relapse than TBI or oral Bu. LFS was better after i.v. or oral Bu compared with TBI.

Original languageEnglish (US)
Pages (from-to)552-558
Number of pages7
JournalBiology of Blood and Marrow Transplantation
Volume21
Issue number3
DOIs
StatePublished - Mar 1 2015

Fingerprint

Busulfan
Whole-Body Irradiation
Homologous Transplantation
Leukemia, Myelogenous, Chronic, BCR-ABL Positive
Cyclophosphamide
Transplants
Unrelated Donors
Leukemia
Survival
HLA Antigens
Siblings
Tissue Donors
Recurrence
Cell Transplantation
Bone Marrow Transplantation
Protein-Tyrosine Kinases
Multivariate Analysis
Transplantation

Keywords

  • Busulfan
  • Chronic myeloid leukemia
  • Total body irradiation

ASJC Scopus subject areas

  • Transplantation
  • Hematology

Cite this

Comparison of Outcomes of Allogeneic Transplantation for Chronic Myeloid Leukemia with Cyclophosphamide in Combination with Intravenous Busulfan, Oral Busulfan, or Total Body Irradiation. / Copelan, Edward A.; Avalos, Belinda R.; Ahn, Kwang Woo; Zhu, Xiaochun; Gale, Robert Peter; Grunwald, Michael R.; Hamadani, Mehdi; Hamilton, Betty K.; Hale, Gregory A.; Marks, David I.; Waller, Edmund K.; Savani, Bipin N.; Costa, Luciano J.; Ramanathan, Muthalagu; Cahn, Jean Yves; Khoury, H. Jean; Weisdorf, Daniel J.; Inamoto, Yoshihiro; Kamble, Rammurti T.; Schouten, Harry C.; Wirk, Baldeep; Litzow, Mark R; Aljurf, Mahmoud D.; van Besien, Koen W.; Ustun, Celalettin; Bolwell, Brian J.; Bredeson, Christopher N.; Fasan, Omotayo; Ghosh, Nilanjan; Horowitz, Mary M.; Arora, Mukta; Szer, Jeffrey; Loren, Alison W.; Alyea, Edwin P.; Cortes, Jorge; Maziarz, Richard T.; Kalaycio, Matt E.; Saber, Wael.

In: Biology of Blood and Marrow Transplantation, Vol. 21, No. 3, 01.03.2015, p. 552-558.

Research output: Contribution to journalArticle

Copelan, EA, Avalos, BR, Ahn, KW, Zhu, X, Gale, RP, Grunwald, MR, Hamadani, M, Hamilton, BK, Hale, GA, Marks, DI, Waller, EK, Savani, BN, Costa, LJ, Ramanathan, M, Cahn, JY, Khoury, HJ, Weisdorf, DJ, Inamoto, Y, Kamble, RT, Schouten, HC, Wirk, B, Litzow, MR, Aljurf, MD, van Besien, KW, Ustun, C, Bolwell, BJ, Bredeson, CN, Fasan, O, Ghosh, N, Horowitz, MM, Arora, M, Szer, J, Loren, AW, Alyea, EP, Cortes, J, Maziarz, RT, Kalaycio, ME & Saber, W 2015, 'Comparison of Outcomes of Allogeneic Transplantation for Chronic Myeloid Leukemia with Cyclophosphamide in Combination with Intravenous Busulfan, Oral Busulfan, or Total Body Irradiation', Biology of Blood and Marrow Transplantation, vol. 21, no. 3, pp. 552-558. https://doi.org/10.1016/j.bbmt.2014.12.010
Copelan, Edward A. ; Avalos, Belinda R. ; Ahn, Kwang Woo ; Zhu, Xiaochun ; Gale, Robert Peter ; Grunwald, Michael R. ; Hamadani, Mehdi ; Hamilton, Betty K. ; Hale, Gregory A. ; Marks, David I. ; Waller, Edmund K. ; Savani, Bipin N. ; Costa, Luciano J. ; Ramanathan, Muthalagu ; Cahn, Jean Yves ; Khoury, H. Jean ; Weisdorf, Daniel J. ; Inamoto, Yoshihiro ; Kamble, Rammurti T. ; Schouten, Harry C. ; Wirk, Baldeep ; Litzow, Mark R ; Aljurf, Mahmoud D. ; van Besien, Koen W. ; Ustun, Celalettin ; Bolwell, Brian J. ; Bredeson, Christopher N. ; Fasan, Omotayo ; Ghosh, Nilanjan ; Horowitz, Mary M. ; Arora, Mukta ; Szer, Jeffrey ; Loren, Alison W. ; Alyea, Edwin P. ; Cortes, Jorge ; Maziarz, Richard T. ; Kalaycio, Matt E. ; Saber, Wael. / Comparison of Outcomes of Allogeneic Transplantation for Chronic Myeloid Leukemia with Cyclophosphamide in Combination with Intravenous Busulfan, Oral Busulfan, or Total Body Irradiation. In: Biology of Blood and Marrow Transplantation. 2015 ; Vol. 21, No. 3. pp. 552-558.
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abstract = "Cyclophosphamide (Cy) in combination with busulfan (Bu) or total body irradiation (TBI) is the most commonly used myeloablative conditioning regimen in patients with chronic myeloid leukemia (CML). We used data from the Center for International Bone Marrow Transplantation Research to compare outcomes in adults who underwent hematopoietic cell transplantation for CML in first chronic phase after myeloablative conditioning with Cy in combination with TBI, oral Bu, or intravenous (i.v.) Bu. Four hundred thirty-eight adults received human leukocyte antigen (HLA)-matched sibling grafts and 235 received well-matched grafts from unrelated donors (URD) from 2000 through 2006. Important differences existed between the groups in distribution of donor relation, exposure to tyrosine kinase inhibitors, and year of transplantation. In multivariate analysis, relapse occurred less frequently among patients receiving i.v. Bu compared with TBI (relative risk [RR], .36; P=022) or oral Bu (RR, .39; P=028), but nonrelapse mortality and survival were similar. A significant interaction was detected between donor relation and the main effect in leukemia-free survival (LFS). Among recipients of HLA-identical sibling grafts, but not URD grafts, LFS was better in patients receiving i.v. Bu (RR, .53; P=025) or oral Bu (RR, .64; P=017) compared with TBI. In CML in first chronic phase, Cy in combination with i.v. Bu was associated with less relapse than TBI or oral Bu. LFS was better after i.v. or oral Bu compared with TBI.",
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AU - Ahn, Kwang Woo

AU - Zhu, Xiaochun

AU - Gale, Robert Peter

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AU - Ramanathan, Muthalagu

AU - Cahn, Jean Yves

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AU - Weisdorf, Daniel J.

AU - Inamoto, Yoshihiro

AU - Kamble, Rammurti T.

AU - Schouten, Harry C.

AU - Wirk, Baldeep

AU - Litzow, Mark R

AU - Aljurf, Mahmoud D.

AU - van Besien, Koen W.

AU - Ustun, Celalettin

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AU - Bredeson, Christopher N.

AU - Fasan, Omotayo

AU - Ghosh, Nilanjan

AU - Horowitz, Mary M.

AU - Arora, Mukta

AU - Szer, Jeffrey

AU - Loren, Alison W.

AU - Alyea, Edwin P.

AU - Cortes, Jorge

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N2 - Cyclophosphamide (Cy) in combination with busulfan (Bu) or total body irradiation (TBI) is the most commonly used myeloablative conditioning regimen in patients with chronic myeloid leukemia (CML). We used data from the Center for International Bone Marrow Transplantation Research to compare outcomes in adults who underwent hematopoietic cell transplantation for CML in first chronic phase after myeloablative conditioning with Cy in combination with TBI, oral Bu, or intravenous (i.v.) Bu. Four hundred thirty-eight adults received human leukocyte antigen (HLA)-matched sibling grafts and 235 received well-matched grafts from unrelated donors (URD) from 2000 through 2006. Important differences existed between the groups in distribution of donor relation, exposure to tyrosine kinase inhibitors, and year of transplantation. In multivariate analysis, relapse occurred less frequently among patients receiving i.v. Bu compared with TBI (relative risk [RR], .36; P=022) or oral Bu (RR, .39; P=028), but nonrelapse mortality and survival were similar. A significant interaction was detected between donor relation and the main effect in leukemia-free survival (LFS). Among recipients of HLA-identical sibling grafts, but not URD grafts, LFS was better in patients receiving i.v. Bu (RR, .53; P=025) or oral Bu (RR, .64; P=017) compared with TBI. In CML in first chronic phase, Cy in combination with i.v. Bu was associated with less relapse than TBI or oral Bu. LFS was better after i.v. or oral Bu compared with TBI.

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