Skip to main content

Table 2 Myeloablative conditioning regimens in allogeneic hematopoietic stem cell transplantation for Philadelphia chromosome-positive acute lymphoblastic leukemia

From: Allogeneic hematopoietic stem cell transplantation in adult acute lymphoblastic leukemia: potential benefit of medium-dose etoposide conditioning

Regimen No. of ALL Mean age (range) Donor Stem cell source Disease status at HSCT Survival rate Relapse rate TRM/NRM aGVHD cGVHD Remarks Reference
ETP 60 mg/kg × 1 + TBI 1.2 Gy × 11 5 28 (23–45) MRD BM CR1: 4 OS: 60 % (171 d) 0 % 40 % 50 % (gr.II: 33 %) ND Intensified conditioning regimens followed by allogeneic HSCT were a preferred treatment modality for Ph + ALL according to a retrospective sutdy. Forman SJ, et al. Blood 1987; 70:587
ETP 60 mg/kg × 1 + TBI 7.5 Gy × 1 1 Non-CR: 6
CY 100 mg/kg × 1 + TBI 1.2 Gy × 11 3
BU 1 mg/kg × 16 + CY 60 mg/kg × 1 1
BU + CY +TBI 67 28 (5–49) MRD BM CR1: 33 2-Y DFS: 38 % 34 % CR1: 42 % Gr.II: 24 % 33 % Allogeneic HSCT was feasible for Ph+ ALL patients according to a retrospective study using IBMTR data. The dose of conditioning regimens was not specified. Barrett AJ, et al. Blood 1992; 79:3067.
Rel: 22 2-Y DFS: 41 % 32 % Rel: 40 % : 38 % 31 %
IF: 12 2-Y DFS: 25 % 57 % IF : 42 % : 45 % 22 %
CY 60 mg/kg × 2 + TBI 1.2 Gy × 11 (for patients 18 y) 15 25 (17–51) MUD BM CR1: 7 2-Y DFS: 49 % 29 % 22 % 100 % (gr.II: 75 %) 62 % (ext. 54 %) Unrelated HLA-matched donors were useful when related HLA-matched donors were not found in a retrospective study. Sierra J, et al. Blood 1997; 90:1410.
CY 60 mg/kg × 2 + TBI 1.2 Gy × 12 (for children) 3 >CR1: 1
Non-CR: 10
ETP 50 mg/kg × 1 + TBI 1.2 Gy × 11+/–CY 60 mg/kg x 2 22 30 (6–42) MRD BM/PB CR1 3-Y DFS: all 65 % 12 % 30 % 65 % 65 % The relatively low relapse rate might reflect the enhanced anti-leukemic activity of ETP/TBI compared to other conditioning regimens in a retrospective study. Snyder DS, et al. Leukemia 1999; 13:2053.
CY 60 mg/kg × 2 + TBI 1.2 Gy × 11 1 <1992 : 45 %  
1992: 81 %
ETP 50 mg/kg × 1 +CY 60 mg/kg × 2 +TBI 2 Gy × 6 or TBI 10 Gy × 1 74 42 (17–56) MRD: 43 BM CR1 2-Y OS: 37 % 40 % 67 % ND ND Allogeneic HSCT in CR1 was the best treatment option in Ph+ ALL according to a prospective study. Outcome was better in bcr/abl transcript-negative patients than in bcr-abl transcript-positive ones. The 2-Y OS, relapse, and TRM rates were 26 %, 74 %, and 91 %, respectively in 23 cases of autologous HSCT. Dombret H, et al. Blood 2002;100:2357.
MUD: 8 2-Y OS: 63 % 25 % 38 % ND ND
CY 60 m/kg × 2 + TBI 2Gy × 6 (for adults) Adults: 102 35 (1–53) MRD: 79 BM/PB CR1: 76 2-Y OS: all 37 % 44 % 38 % Adults Gr.II: 52 % 43 % (ext.: 17 %) A better outcome was correlated with remission status at transplant in a prospective study. The relapse rate decreased with the occurrence of acute GVHD. Bcr/abl transcript-positivity did not correlate to relapse rate. Espérou H, et al. Bone Marrow Transplant. 2003;31:909.
Ara-C 3 g/m2 × 4 or 6 + Mel 140 mg/m2 × 1 +TBI 2 Gy × 6 (for children) Children: 19 MUD: 42 >CR1: 45 CR1: 50 % 37 % Children Gr.II: 53 % 39 % (ext.: 8 %)
CY 60 mg/kg × 2 + TBI 2 Gy × 6 166 37 (16–59) MRD: 136 BM: 167 CR1: 93 5-Y OS N.D. N.D. N.D. N.D. Allogeneic HSCT was the only procedure with curative potential for Ph+ ALL according to a retrospective study. Pre-transplant disease status was an important factor for better survival. Extensive cGVHD correlated with a better outcome, while severe aGVHD did not. Yanada M. et al. Bone Marrow Transplant. 2005;36:867.
Non-TBI 31 MUD: 61 PB: 24 :>CR1 19 CR1: 34 %
BM + PB: 6 Non-CR: 85 >CR1: 21 %
5-Y OS
TBI (n = 166): 25 %
Non-TBI (n = 31): 8 %
ETP 60 mg/kg × 1 +TBI 1.2 Gy × 11 67 36 (2–57) MRD BM: 43 CR1:49 10-Y OS   CR1: 31 % 49 % (gr.II: 35 %) 38 % (ext.: 13 %) Disease status at the time of HSCT was important according to a retrospective study. ETP + TBI with or without CY conferred long-term survival. Seventeen patients received imatinib before HSCT and received the drug after HSCT as well. Laport GG, et al.: Blood 2008;112:903.
ETP 60 mg/kg × 1 + CY 60 mg/kg × 2 + TBI 1.2 Gy × 11 11 PB: 36 >CR1:30 CR1: 48 % CR1: 28 % >CR1: 54 %   
ETP 60 mg/kg × 1+BU 1 mg/kg × 16 +TBI 1.2 Gy × 11 1 >CR1: 29 % >CR1: 41 %  
  1. No. the number of patients, ALL acute lymphoblastic leukemia, HSCT hematopoietic stem cell transplantation, TRM transplant-related mortality, NRM non-relapse mortality, aGVHD acute graft-versus-host disease, cGVHD chronic graft-versus-host disease, ETP etoposide, TBI total body irradiation, CY cyclophosphamide, BU busulfan, MRD matched related donor, BM bone marrow, CR complete remission, OS overall survival, d day, gr. grade, ND not determined, Rel relapse, IF induction failure, DFS disease-free survival, ext. extensive type of chronic GVHD, IBMTR international bone marrow transplant registry, MUD matched unrelated donor, HLA human leukocyte antigen, PB peripheral blood, Ara-C cytosine arabinoside