TY - JOUR
T1 - Treosulfan, Fludarabine, and Low-Dose Total Body Irradiation for Children and Young Adults with Acute Myeloid Leukemia or Myelodysplastic Syndrome Undergoing Allogeneic Hematopoietic Cell Transplantation
T2 - Prospective Phase II Trial of the Pediatric Blood and Marrow Transplant Consortium
AU - Nemecek, Eneida R.
AU - Hilger, Ralf A.
AU - Adams, Alexia
AU - Shaw, Bronwen E.
AU - Kiefer, Deidre
AU - Le-Rademacher, Jennifer
AU - Levine, John E.
AU - Yanik, Gregory
AU - Leung, Wing
AU - Talano, Julie An
AU - Haut, Paul
AU - Delgado, David
AU - Kapoor, Neena
AU - Petrovic, Aleksandra
AU - Adams, Roberta
AU - Hanna, Rabi
AU - Rangarajan, Hemalatha
AU - Dalal, Jignesh
AU - Chewning, Joseph
AU - Verneris, Michael R.
AU - Epstein, Stacy
AU - Burroughs, Lauri
AU - Perez-Albuerne, Evelio D.
AU - Pulsipher, Michael A.
AU - Delaney, Colleen
N1 - Publisher Copyright:
© 2018 The American Society for Blood and Marrow Transplantation
PY - 2018/8
Y1 - 2018/8
N2 - This multicenter study evaluated a treosulfan-based regimen in children and young adults with acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS) undergoing allogeneic hematopoietic cell transplant (HCT). Forty patients with median age 11 years (range, 1 to 19) underwent allogeneic HCT for AML in first (n = 18), second (n = 11), and third or greater remission (n = 3) or MDS (n = 8) using bone marrow (n = 25), peripheral blood stem cells (n = 5), or cord blood (n = 9). The regimen consisted of body surface area (BSA)-based treosulfan 10 g/m 2 /day (BSA ≤.5 m 2 ), 12 g/m 2 /day (BSA >.5 to 1.0 m 2 ), or 14 g/m 2 /day (BSA > 1.0 m 2 ) on days −6 to −4; fludarabine 30 mg/m 2 /day on days −6 to −2; and a single fraction of 200 cGy total body irradiation on day −1. Graft-versus-host disease (GVHD) prophylaxis included tacrolimus and methotrexate for marrow and peripheral blood stem cell and cyclosporine/mycophenolate mofetil for cord blood. One-year overall survival, disease-free survival, and nonrelapse mortality were 80%, 73%, and 3%, respectively. One-year relapse was 38% for AML and 13% for MDS. No serious organ toxicities were observed. All 37 assessable patients engrafted. Cumulative incidences of grades II to IV acute GVHD and chronic GVHD were 22% and 40%, respectively. BSA-based treosulfan dosing resulted in predictable area under the curve and maximum concentration, which is required for dosing without measuring individual pharmacokinetic parameters. Observed differences in pharmacokinetics did not impact disease control or regimen toxicity. This BSA-based treosulfan regimen resulted in excellent engraftment and disease-free survival and minimal toxicity and transplant-related mortality (3%) in children and young adults with AML and MDS.
AB - This multicenter study evaluated a treosulfan-based regimen in children and young adults with acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS) undergoing allogeneic hematopoietic cell transplant (HCT). Forty patients with median age 11 years (range, 1 to 19) underwent allogeneic HCT for AML in first (n = 18), second (n = 11), and third or greater remission (n = 3) or MDS (n = 8) using bone marrow (n = 25), peripheral blood stem cells (n = 5), or cord blood (n = 9). The regimen consisted of body surface area (BSA)-based treosulfan 10 g/m 2 /day (BSA ≤.5 m 2 ), 12 g/m 2 /day (BSA >.5 to 1.0 m 2 ), or 14 g/m 2 /day (BSA > 1.0 m 2 ) on days −6 to −4; fludarabine 30 mg/m 2 /day on days −6 to −2; and a single fraction of 200 cGy total body irradiation on day −1. Graft-versus-host disease (GVHD) prophylaxis included tacrolimus and methotrexate for marrow and peripheral blood stem cell and cyclosporine/mycophenolate mofetil for cord blood. One-year overall survival, disease-free survival, and nonrelapse mortality were 80%, 73%, and 3%, respectively. One-year relapse was 38% for AML and 13% for MDS. No serious organ toxicities were observed. All 37 assessable patients engrafted. Cumulative incidences of grades II to IV acute GVHD and chronic GVHD were 22% and 40%, respectively. BSA-based treosulfan dosing resulted in predictable area under the curve and maximum concentration, which is required for dosing without measuring individual pharmacokinetic parameters. Observed differences in pharmacokinetics did not impact disease control or regimen toxicity. This BSA-based treosulfan regimen resulted in excellent engraftment and disease-free survival and minimal toxicity and transplant-related mortality (3%) in children and young adults with AML and MDS.
KW - Acute myeloid leukemia
KW - Conditioning regimen
KW - Myelodysplastic syndromes
KW - Stem cell transplantation
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UR - http://www.scopus.com/inward/citedby.url?scp=85047460893&partnerID=8YFLogxK
U2 - 10.1016/j.bbmt.2018.04.025
DO - 10.1016/j.bbmt.2018.04.025
M3 - Article
C2 - 29753157
AN - SCOPUS:85047460893
SN - 1083-8791
VL - 24
SP - 1651
EP - 1656
JO - Biology of Blood and Marrow Transplantation
JF - Biology of Blood and Marrow Transplantation
IS - 8
ER -