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Table 3 Reduced-intensity conditioning regimens in allogeneic hematopoietic stem cell transplantation for 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
Flu 90–150 mg/m2 + Mel 140 mg/m2 27 50 (18–63) MRD BM CR1: 3 2-Y OS: 31 % 49 % TRM: 23 % Gr.II: 48 % 67 % A small sample sized retrospective study; GVL effect was exhibited. Martino R, et al. Haematologica 2003;88: 555.
Flu + Mel+ Ara-C 2 g/m2 MMRD PB CR2/3:10 GVHD+: 35 % Limt.: 39 %
Flu + 2 Gy TBI MUD PR2:1 GVHD-: 70 % Ext.: 28 %
Flu + Mel+ CAMPATH-1H 200 mg/kg MMUD Non-CR: 12
Flu + CY 60 mg/kg+ Thiotpa 10 mg/kg
Flu 30 mg/m2 × 6 +4 Gy TBI/ATG 10 mg/kg/d × 4 97 38 (15–66) MRD BM CR1:28 2-Y OS: 52 % 40 % CR1, NRM: 18 % Gr.II: 33 % 37 % Factors for better OS were CR1, chronic GVHD, and female donor according to a retrospective study. Mohty M, et al. Haematologica 2008; 93: 303.
Flu + BU 8 mg/kg MUD PB CR2/3: 30 27 % 63 % CR2/CR3, NRM: 17 %
Flu + Mel Non-CR: 39 20 % 49 % More advanced stage, NRM: 44 %
Flu + CY  
Flu 25 mg/m2 × 5+ Mel 140 mg/m2 × 1 24 48 (23–68) MRD PB CR1: 11 2-Y OS: 62 % 21 % NRM: 22 % Gr.II: 63 % 75 % RIC HSCT might offer a promising option for high risk ALL patients not eligible for standard myeloablative transplantation according to a. retrospective study. Stein AS, et al. Biol. Blood Marrow Transplant. 2009; 15: 1407.
MUD CR2: 5 Limit.: 21 %
CR3: 3 Ext.: 54 %
Non-CR 5
Flu 40 mg/m2 × 5+ CY 50 mg/kg+ TBI 2 Gy 22 (high risk) 49 (24–68) MRD PB CR1: 12 3-Y OS: 50 % 36 % TRM: 27 % Gr.II:55 % 45 % In a small sample sized prospective study, HSCT at CR1 showed an excellent outcome, but the relapse rate was high. Bachanova V, et al. Blood 2009; 113: 2902.
MUD CB CR2: 10 Gr.III: 20 % Ext.: 32 %
Flu 30 mg/m2 × 5 +Mel 70 mg/m2 × 2 +/−ATG 2.5 mg/kg 37 45 (15–63) MRD PB CR1: 30 3-Y OS: 64 % 20 % NRM: 18 % Gr.II: 43 % 66 % Transplant in CR1 showed a better outcome in a prospective phase II study. GVL effect was induced in cGVHD. Cho B-S, et al. Leukemia 2009;23:1763.
MUD BM CR2: 7 Limit: 28 %
MMUD Ext: 38 %
BU 9 mg/kg or less + Mel 150 mg/m2 or less+ TBI >5 Gy or fractionated 93 45 (17–66) MRD: 30 PB: 68 CR1: 55 3-Y OS: 38 % (RIC) 35 % (RIC) RIC    TRM rate in RIC was almost the same as that in MAC, but the relapse rate was higher in RIC (35 % vs 26 %) according to a retrospective study. Marks DI, et al. Blood 2010;116:366
TBI >8 Gy MUD: 36 BM: 25 CR2: 38 3-Y OS: 43 % (MAC) 26 % (MAC) TRM: 32 % Gr.II: 39 % 34 %
Flu + TBI 2 Gy PMMUD: 20 3-Y DFS: 32 % (RIC) MAC
Others MMUD: 5 3-Y DFS: 41 % (MAC) TRM: 33 % Gr.II: 46 % 42 %
UD: 2
  1. No. the number of patients, ALL acute lymphoblastic leukemia, HSCT hematopoietic stem cell transplantation, TRM transplant-related mortality, NRM nonrelapse mortality, aGVHD acute graft-versus-host disease, cGVHD chronic graft-versus-host disease, Flu fludarabine, Mel melphalan, Ara-C cytosine arabinoside, Gy gray, TBI total body irradiation, CY cyclophosphamide, MRD matched related donor, MMRD mismatched related donor, MUD matched unrelated donor, MMUD mismatched unrelated donor, BM bone marrow, PB peripheral blood, CR complete remission, PR partial remission, Y year, OS overall survival, gr. grade, Limit. limited type of cGVHD, Ext. extensive type of cGVHD, GVL graft-versus-leukemia, ATG anti-thymocyte globulin, BU busulfan, Ph Philadelphia chromosome, RIC reduced-intensity conditioning, CB cord blood, PMMUD partially mismatched unrelated donor, UD unknown donor, DFS disease-free survival, MAC myeloablative conditioning regimen