Thiotepa‐based versus total body irradiation‐based myeloablative conditioning prior to allogeneic stem cell transplantation for acute myeloid leukaemia in first complete remission: a retrospective analysis from the Acute Leukemia Working Party of the European Group for Blood and Marrow Transplantation |
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| Authors: | Sandra Eder Myriam Labopin William Arcese Reuven Or Ignazio Majolino Andrea Bacigalupo Gennaro de Rosa Liisa Volin Dietrich Beelen Hendrik Veelken Nicolaas P M Schaap Jurgen Kuball Jan Cornelissen Arnon Nagler Mohamad Mohty the Acute Leukemia Working Party |
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| Institution: | 1. EBMT Office Paris, H?pital Saint‐Antoine, Paris, France;2. Rome Transplant Network “Tor Vergata”, University of Rome Stem Cell Transplant Unit, Rome, Italy;3. Department of Bone Marrow Transplantation, Hadassah University Hospital, Jerusalem, Israel;4. Haematology & SCT Unit, Ospedale S. Camillo, Rome, Italy;5. Department of Haematology II, Ospedale San Martino, Genova, Italy;6. Division of Hematology, University of Napoli Federico II Medical School, Napoli, Italy;7. Helsinki University Central Hospital, Helsinki, Finland;8. Department of Bone Marrow Transplantation, University Hospital of Essen, Essen, Germany;9. Department of Hematology, Leiden University Medical Center, Leiden, The Netherlands;10. Department of Hematology, Radboud University Medical Centre, Nijmegen, The Netherlands;11. Department of Haematology, University Medical Centre, Utrecht, The Netherlands;12. Erasmus MC‐Daniel den Hoed Cancer Centre, Rotterdam, The Netherlands;13. Chaim Sheba Medical Center, Tel Hashomer, Israel;14. Service d'Hématologie et Thérapie Cellulaire, H?pital Saint Antoine, Paris, France |
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| Abstract: | Thiotepa is an alkylating compound with an antineoplastic and myeloablative activity and can mimic the effect of radiation. However, it is unknown whether this new regimen could safely replace the long‐established ones. This retrospective matched‐pair analysis evaluated the outcome of adults with acute myeloid leukaemia in first complete remission who received myeloablative conditioning either with a thiotepa‐based (n = 121) or a cyclophosphamide/total body irradiation‐based (TBI; n = 358) regimen for allogeneic hematopoietic stem cell transplantation from an HLA‐matched sibling or an unrelated donor. With a median follow‐up of 44 months, the outcome was similar in both groups. Acute graft‐versus‐host disease grade II‐IV was observed in 25% after thiotepa‐containing regimen versus 35% after TBI (P = 0.06). The 2‐yr cumulative incidence of chronic graft‐versus‐host disease was 40.5% for thiotepa and 41% for TBI (P = 0.98). At 2 yrs, the cumulative incidences of non‐relapse mortality and relapse incidence were 23.9% (thiotepa) vs. 22.4% (TBI; P = 0.66) and 17.2% (thiotepa) vs. 23.3% (TBI; P = 0.77), respectively. The probabilities of leukaemia‐free and overall survival at 2 yrs were not significantly different between the thiotepa and TBI groups, at 58.9% vs. 54.2% (P = 0.95) and 61.4% vs. 58% (P = 0.72), respectively. Myeloablative regimens using combinations including thiotepa can provide satisfactory outcomes, but the optimal conditioning remains unclear for the individual patient in this setting. |
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| Keywords: | acute myeloid leukaemia allo‐HSCT thiotepa total body irradiation |
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