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大学・研究所にある論文を検索できる 「Adult patients with Ph+ ALL benefit from conditioning regimen of medium‐dose VP16 plus CY/TBI」の論文概要。リケラボ論文検索は、全国の大学リポジトリにある学位論文・教授論文を一括検索できる論文検索サービスです。
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Adult patients with Ph+ ALL benefit from conditioning regimen of medium‐dose VP16 plus CY/TBI

Morita-Fujita, Mari Arai, Yasuyuki Kondo, Tadakazu Harada, Kaito Uchida, Naoyuki Toya, Takashi Ozawa, Yukiyasu Fukuda, Takahiro Ota, Shuichi Onizuka, Makoto Kanda, Yoshinobu Maruyama, Yumiko Takada, Satoru Kawakita, Toshiro Ara, Takahide Ichinohe, Tatsuo Kimura, Takafumi Atsuta, Yoshiko Kako, Shinichi 京都大学 DOI:10.1002/hon.3046

2022.12

概要

The medium‐dose etoposide (VP16) added on cyclophosphamide (CY)/total body irradiation (TBI) is one of the intensified myeloablative conditioning regimens used in allogenic hematopoietic stem cell transplantation (allo‐HSCT) for acute lympho- blastic leukemia (ALL). However, the patient subgroups who can actually benefit from VP16/CY/TBI compared to CY/TBI have not been precisely defined. Therefore,we conducted a multi‐center retrospective study using the Japanese nationwide registry database to elucidate the efficacy of VP16/CY/TBI on post‐transplant prognosis. Biological and clinical distinct subtypes (i.e., Philadelphia chromosome‐ positive (Ph+) and ‐negative (Ph−) ALL) were evaluated separately, which included 820 Ph+ and 1463 patients with Ph− ALL, respectively. Compared with the CY/TBI group, the VP16/CY/TBI group showed superior progression‐free survival (PFS) in patients with Ph+ ALL (65% vs. 57% at 3 years after HSCT; adjusted hazard ratio (HR), 0.73; 95% confidence interval (CI), 0.55–0.98; p = 0.03), along with significantly reduced incidence of relapse (adjusted HR, 0.58; 95% CI, 0.37–0.90; p = 0.02) without the increase of non‐relapse mortality (NRM). By contrast, in pa- tients with Ph− ALL, VP16/CY/TBI did not improve PFS nor incidence of relapse; addition of VP16 reduced relapse (HR, 0.65; p = 0.06) in patients with Ph− ALL transplanted at CR1, while improved PFS was not observed (HR, 0.90; p = 0.52) due to increased NRM. This study demonstrated that VP16/CY/TBI is a more effective and well‐tolerated regimen in comparison with CY/TBI in patients with myeloa- blative allo‐HSCT for adult Ph+ ALL. Our findings can provide a novel algorithm for conditioning regimen selection in patients with adult ALL.

KEYWORDS
acute lymphoblastic leukemia, Philadelphia chromosome, VP16/CY/TBI

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