Busulfan plus cyclophosphamide vs. total body irradiation plus cyclophosphamide for allogeneic hematopoietic stem cell transplantation in patients with acute T lymphoblastic leukemia: a large-scale propensity score-based study

Author:

Xu Yang1ORCID,Shen Yifan2,Liu Minyuan,Shen Danya1,Chu Mengqian3,Li Xuekai1,Zhang Xiang1,Fan Yi1,Chen Jia3,Wu Depei3,Hu Shaoyan4

Affiliation:

1. National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China

2. National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health

3. The First Affiliated Hospital of Soochow University

4. Children’s Hospital of Soochow University

Abstract

Abstract Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is considered as a promising treatment option for T-cell acute lymphoblastic leukemia (T-ALL). However, the clinical prognosis outcomes of allo-HSCT in T-ALL patients following the two myeloablative conditioning regimens, total body irradiation plus cyclophosphamide (TBI-Cy) and busulfan plus cyclophosphamide (BuCy), have not yet been determined. We conducted a retrospective analysis on 222 patients with T-ALL. Of these, 83 received TBI-Cy and 139 received BuCy as conditioning regimens. The analysis was conducted after propensity score matching based on a large-scale data between 2012 and 2022. The TBI-Cy conditioning regimen resulted in significantly higher 2-year overall survival (OS) and progression-free survival (PFS) compared to the BuCy conditioning regimen (OS: 73.9% vs. 53.7%, p = 0.003; PFS: 58.6% vs.46.0%, p = 0.020). The improved survival outcomes may be attributed to the reduced cumulative incidence of relapse (CIR). The 2-year CIR was 35.7% in the TBI-Cy group, and 46.4% in the BuCy group (p = 0.036). Additionally, there was no significant difference in non-relapse mortality (NRM) between the two groups, with a 2-year NRM of 8.0% in the TBI-Cy group and 12.6% following the BuCy group (p = 0.315). Patients with extramedullary disease prior to allo-HSCT or were in no remission (NR) at allo-HSCT who received the TBI-Cy conditioning regimen showed improved survival outcomes compared to those who received the BuCy conditioning regimen. Multivariate analysis confirmed that the TBI-Cy conditioning regimen was an independent predictive factor for improved OS and PFS and reduced CIR. In conclusion, TBI-Cy conditioning regimen appears to be a safe and effective choice for allo-HSCT in T-ALL patients.

Publisher

Research Square Platform LLC

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