Etoposide Containing Preparative Regimen for Allogeneic Hematopoietic Stem Cell Transplantation in Patients with Acute Lymphoblastic Leukemia.

[Purpose] Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is one of the powerful therapeutic tools for patients with adult lymphoblastic leukemia (ALL) even though transplant-related toxicity and the recurrence of leukemia are still problematic. In order to improve outcome of patients with adult ALL who received allo-HSCT, we investigated the clinical efficacy and safety of etoposide containing conditioning regimen for allo-HSCT.

[Patients and Methods] Adult patients (including patients with 17, 18 and 19 years of age) with ALL were treated between February 1991 and October 2003 in our institute. When patients attained complete remission (CR) by induction therapies using JALSG ALL protocols or others, they received allo-HSCT [bone marrow (BMT), peripheral blood stem cell (PBSCT), and cord blood transplantation (CBT)]. Conditioning regimen was consisted with etoposide (60 mg/kg), cyclophosphamide (120 mg/kg), and fractionated total body irradiation (10 Gy) (CY/ETP/TBI). As clinically indicated, cytosine arabinoside (CY/ETP/TBI/AraC) or nimustine hydrochloride (CY/ETP/TBI/ACNU) was added to CY/ETP/TBI.

[Results] In the 23 patients [male/female: 15/8, median age was 30 years (range 17–50 years)], 19 patients received BMT (13 from related and 6 from un-related donor), 3 received PBSCT from related donor, and one was performed CBT. As the conditioning regimen, 16 patients received CY/ETP/TBI, 4 received CY/ETP/TBI/AraC, and 3 received CY/ETP/TBI/ACNU. Six out of 23 patients had Philadelphia chromosome positive ALL. Twenty-two patients received HLA serologically identical donor. Remission status at transplant included 16 patients in 1st CR, 5 in 2nd CR, and other 2 patients in non-CR. Grade II toxicity according to Bearman scale was observed in 52% (stomatitis), 22% (gastrointestinal), 9% (bladder), 4% (hepatic), and 4% (cardiac). Critical regimen-related toxicities and fatal veno-occlusive disease were not observed in any patients. The disease-free (DFS) and over-all survival (OS) rate of all patients was 51.1 % and 55.8 %.

[Discussion/Conclusion] These results indicated that an intensified etoposide containing preparative regimen is a feasible regimen and it has good efficacy for transplant recipients with ALL.