eJHaem (Jun 2025)
Efficacy of Total‐Body Irradiation‐based Intensified Myeloablative Regimens for Acute Leukemia—An International Collaborative Study
- Yasuyuki Arai,
- Ruta Brazauskas,
- Naya He,
- A. Samer Al‐Homsi,
- Saurabh Chhabra,
- Minoo Battiwalla,
- Masamitsu Yanada,
- Amir Steinberg,
- Miguel Angel Diaz Perez,
- Sanghee Hong,
- Junya Kanda,
- Asad Bashey,
- Haydar A. Frangoul,
- Sherif M. Badawy,
- Leo F. Verdonck,
- Hillard M. Lazarus,
- Jean A. Yared,
- Hasan Hashem,
- Akshay Sharma,
- Mahmoud Aljurf,
- Ajoy L. Dias,
- Muhammad Bilal Abid,
- Baldeep Wirk,
- César O. Freytes,
- Amer M. Zeidan,
- Usama Gergis,
- Amer Beitinjaneh,
- Medhat Askar,
- Jeffrey J. Pu,
- Leslie E. Lehmann,
- Hemalatha G. Rangarajan,
- William A. Wood,
- Shahrukh Hashmi,
- Shingo Yano,
- Shinichi Kako,
- Yukiyasu Ozawa,
- Noriko Doki,
- Yoshinobu Kanda,
- Takahiro Fukuda,
- Yuta Katayama,
- Tatsuo Ichinohe,
- Junji Tanaka,
- Takanori Teshima,
- Shinichiro Okamoto,
- Yoshiko Atsuta,
- Wael Saber
Affiliations
- Yasuyuki Arai
- Department of Hematology Graduate School of Medicine Kyoto University Kyoto Japan
- Ruta Brazauskas
- Division of Biostatistics Institute for Health and Equity Medical College of Wisconsin Milwaukee Wisconsin USA
- Naya He
- CIBMTR (Center for International Blood and Marrow Transplant Research) Department of Medicine, Medical College of Wisconsin Milwaukee Wisconsin USA
- A. Samer Al‐Homsi
- New York University Grossman School of Medicine New York University Langone Health New York New York USA
- Saurabh Chhabra
- Division of Hematology/Oncology Department of Medicine Mayo Clinic Arizona Phoenix Arizona USA
- Minoo Battiwalla
- Sarah Cannon Transplant and Cell Therapy Network Nashville Tennessee USA
- Masamitsu Yanada
- Department of Hematology and Oncology Nagoya City University East Medical Center Nagoya Japan
- Amir Steinberg
- Westchester Medical Center Valhalla New York USA
- Miguel Angel Diaz Perez
- Department of Hematology/Oncology Hospital Infantil Universitario Niño Jesus Madrid Spain
- Sanghee Hong
- Division of Hematologic Malignancies and Cellular Therapy Department of Medicine Duke University School of Medicine Durham North Carolina USA
- Junya Kanda
- Department of Hematology Graduate School of Medicine Kyoto University Kyoto Japan
- Asad Bashey
- Blood and Marrow Transplant Program at Northside Hospital Atlanta Georgia USA
- Haydar A. Frangoul
- The Children's Hospital at TriStar Centennial Medical Center Nashville Tennessee USA
- Sherif M. Badawy
- Department of Pediatrics Northwestern University Feinberg School of Medicine Chicago Illinois USA
- Leo F. Verdonck
- Department of Hematology/Oncology Isala Clinic Zwolle the Netherlands
- Hillard M. Lazarus
- University Hospitals Cleveland Medical Center Case Western Reserve University Cleveland Ohio USA
- Jean A. Yared
- Department of Medicine, Division of Hematology/Oncology, Greenebaum Comprehensive Cancer Center Transplantation & Cellular Therapy Program, University of Maryland Baltimore Maryland USA
- Hasan Hashem
- Division of Pediatric Hematology/Oncology and Bone Marrow Transplantation King Hussein Cancer Center Amman Jordan
- Akshay Sharma
- Department of Bone Marrow Transplantation and Cellular Therapy St. Jude Children's Research Hospital Memphis Tennessee USA
- Mahmoud Aljurf
- Oncology Center King Faisal Specialist Hospital Center & Research Riyadh Saudi Arabia
- Ajoy L. Dias
- Beth Israel Deaconess Medical Center Boston Massachusetts USA
- Muhammad Bilal Abid
- Divisions of Hematology/Oncology & Infectious Diseases BMT & Cellular Therapy Program, Medical College of Wisconsin Milwaukee Wisconsin USA
- Baldeep Wirk
- Bone Marrow Transplant Program Virginia Commonwealth University Richmond Virginia USA
- César O. Freytes
- University of Texas Health Science Center at San Antonio San Antonio Texas USA
- Amer M. Zeidan
- Department of Internal Medicine Section of Hematology Yale School of Medicine and Yale Cancer Center Yale University New Haven Connecticut USA
- Usama Gergis
- Department of Medical Oncology Division of Hematological Malignancies Thomas Jefferson University Philadelphia Pennsylvania USA
- Amer Beitinjaneh
- Division of Transplantation and Cellular Therapy University of Miami Hospital and Clinics Sylvester Comprehensive Cancer Center Miami Florida USA
- Medhat Askar
- QU Health Cluster and College of Medicine Qatar University Doha Qatar
- Jeffrey J. Pu
- VA Boston Medical Center/Brigham and Women's Hospital Harvard Medical School Boston Massachusetts USA
- Leslie E. Lehmann
- Dana Farber Boston Children's Cancer and Blood Disorder Center Boston Massachusetts USA
- Hemalatha G. Rangarajan
- Department of Pediatric Hematology Oncology, Blood and Marrow Transplantation Nationwide Children's Hospital Columbus Ohio USA
- William A. Wood
- Department of Medicine Division of Hematology University of North Carolina Chapel Hill North Carolina USA
- Shahrukh Hashmi
- Department of Medicine Sheikh Shakhbout Medical City Abu Dhabi UAE
- Shingo Yano
- Department of Hematology Jikei University School of Medicine Tokyo Japan
- Shinichi Kako
- Division of Hematology Jichi Medical University Saitama Medical Center Saitama Japan
- Yukiyasu Ozawa
- Department of Hematology Japanese Red Cross Nagoya First Hospital Nagoya Japan
- Noriko Doki
- Hematology Division Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital Tokyo Japan
- Yoshinobu Kanda
- Division of Hematology Jichi Medical University Saitama Medical Center Saitama Japan
- Takahiro Fukuda
- Department of Hematopoietic Stem Cell Transplantation National Cancer Center Hospital Tokyo Japan
- Yuta Katayama
- Department of Hematology Hiroshima Red Cross Hospital & Atomic‐bomb Survivors Hospital Hiroshima Japan
- Tatsuo Ichinohe
- Department of Hematology and Oncology Research Institute for Radiation Biology and Medicine Hiroshima University Hiroshima Japan
- Junji Tanaka
- Department of Hematology Tokyo Women's Medical University Tokyo Japan
- Takanori Teshima
- Department of Hematology Faculty of Medicine Hokkaido University Sapporo Japan
- Shinichiro Okamoto
- Division of Hematology Department of Medicine Keio University School of Medicine Tokyo Japan
- Yoshiko Atsuta
- Japanese Data Center for Hematopoietic Cell Transplantation Nagoya Japan
- Wael Saber
- CIBMTR (Center for International Blood and Marrow Transplant Research) Department of Medicine, Medical College of Wisconsin Milwaukee Wisconsin USA
- DOI
- https://doi.org/10.1002/jha2.70061
- Journal volume & issue
-
Vol. 6,
no. 3
pp. n/a – n/a
Abstract
ABSTRACT Background In this study, we compared outcomes of intensified myeloablative conditioning regimens using large registry data from Japan (Japanese Society for Transplantation and Cellular Therapy) and the United States (Center for International Blood and Marrow Transplant Research). Methods Adult patients who underwent their first myeloablative allogeneic hematopoietic stem cell transplantation (HSCT) for acute leukemia in remission between 2010 and 2018 using conditioning regimens of cyclophosphamide plus total‐body irradiation (CY/TBI), CY/TBI+cytarabine (AraC), or CY/TBI+etoposide (VP16) were included. Results The acute myeloid leukemia (AML) cohort (N = 480, 38.8%) indicated that overall survival (OS) was poorer in CY/TBI+AraC (hazard ratio [HR] 1.46, p < 0.001) and CY/TBI+VP16 (HR 1.39, p = 0.059) compared to CY/TBI. Relapse was not suppressed, while treatment‐related mortality (TRM) was significantly higher (HR 1.78 and 1.74, p < 0.001 and 0.018, respectively). In the acute lymphoblastic leukemia (ALL) cohort (N = 3901, 61.2%), OS was comparable among these regimens. With intensified regimens, relapse was significantly suppressed in CY/TBI+VP16 (HR 0.74, p = 0.005), while TRM was higher (HR 1.21, p = 0.077). No interactions were observed regarding the country. Conclusion In AML adding AraC and VP16 to CY/TBI had an adverse effect on OS. Conversely, in ALL, adding VP16 or AraC to CY/TBI did not affect survival, but the addition of VP16 reduced the risk of relapse. Clinical Trial Registration The authors have confirmed clinical trial registration is not needed for this submission.
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