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Article: 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: Prospective Phase II Trial of the Pediatric Blood and Marrow Transplant Consortium

TitleTreosulfan, Fludarabine, and Low-Dose Total Body Irradiation for Children and Young Adults with Acute Myeloid Leukemia or Myelodysplastic Syndrome Undergoing Allogeneic Hematopoietic Cell Transplantation: Prospective Phase II Trial of the Pediatric Blood and Marrow Transplant Consortium
Authors
KeywordsConditioning regimen
Myelodysplastic syndromes
Stem cell transplantation
Acute myeloid leukemia
Issue Date2018
Citation
Biology of Blood and Marrow Transplantation, 2018, v. 24, n. 8, p. 1651-1656 How to Cite?
Abstract© 2018 The American Society for Blood and Marrow Transplantation. 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.
Persistent Identifierhttp://hdl.handle.net/10722/294522
ISSN
2022 Impact Factor: 4.3
2020 SCImago Journal Rankings: 2.301
PubMed Central ID
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorNemecek, Eneida R.-
dc.contributor.authorHilger, Ralf A.-
dc.contributor.authorAdams, Alexia-
dc.contributor.authorShaw, Bronwen E.-
dc.contributor.authorKiefer, Deidre-
dc.contributor.authorLe-Rademacher, Jennifer-
dc.contributor.authorLevine, John E.-
dc.contributor.authorYanik, Gregory-
dc.contributor.authorLeung, Wing-
dc.contributor.authorTalano, Julie An-
dc.contributor.authorHaut, Paul-
dc.contributor.authorDelgado, David-
dc.contributor.authorKapoor, Neena-
dc.contributor.authorPetrovic, Aleksandra-
dc.contributor.authorAdams, Roberta-
dc.contributor.authorHanna, Rabi-
dc.contributor.authorRangarajan, Hemalatha-
dc.contributor.authorDalal, Jignesh-
dc.contributor.authorChewning, Joseph-
dc.contributor.authorVerneris, Michael R.-
dc.contributor.authorEpstein, Stacy-
dc.contributor.authorBurroughs, Lauri-
dc.contributor.authorPerez-Albuerne, Evelio D.-
dc.contributor.authorPulsipher, Michael A.-
dc.contributor.authorDelaney, Colleen-
dc.date.accessioned2020-12-03T08:22:55Z-
dc.date.available2020-12-03T08:22:55Z-
dc.date.issued2018-
dc.identifier.citationBiology of Blood and Marrow Transplantation, 2018, v. 24, n. 8, p. 1651-1656-
dc.identifier.issn1083-8791-
dc.identifier.urihttp://hdl.handle.net/10722/294522-
dc.description.abstract© 2018 The American Society for Blood and Marrow Transplantation. 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.-
dc.languageeng-
dc.relation.ispartofBiology of Blood and Marrow Transplantation-
dc.subjectConditioning regimen-
dc.subjectMyelodysplastic syndromes-
dc.subjectStem cell transplantation-
dc.subjectAcute myeloid leukemia-
dc.titleTreosulfan, Fludarabine, and Low-Dose Total Body Irradiation for Children and Young Adults with Acute Myeloid Leukemia or Myelodysplastic Syndrome Undergoing Allogeneic Hematopoietic Cell Transplantation: Prospective Phase II Trial of the Pediatric Blood and Marrow Transplant Consortium-
dc.typeArticle-
dc.description.naturelink_to_OA_fulltext-
dc.identifier.doi10.1016/j.bbmt.2018.04.025-
dc.identifier.pmid29753157-
dc.identifier.pmcidPMC6108922-
dc.identifier.scopuseid_2-s2.0-85047460893-
dc.identifier.volume24-
dc.identifier.issue8-
dc.identifier.spage1651-
dc.identifier.epage1656-
dc.identifier.eissn1523-6536-
dc.identifier.isiWOS:000443668100017-
dc.identifier.issnl1083-8791-

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