Cyclophosphamide (Cy) in combination with busulfan (Bu) or total body irradiation (TBI) is the most commonly used myeloablative conditioning regimen in patients with chronic myeloid leukemia (CML). We used data from the Center for International Bone Marrow Transplantation Research to compare outcomes in adults who underwent hematopoietic cell transplantation for CML in first chronic phase after myeloablative conditioning with Cy in combination with TBI, oral Bu, or intravenous (i.v.) Bu. Four hundred thirty-eight adults received human leukocyte antigen (HLA)-matched sibling grafts and 235 received well-matched grafts from unrelated donors (URD) from 2000 through 2006. Important differences existed between the groups in distribution of donor relation, exposure to tyrosine kinase inhibitors, and year of transplantation. In multivariate analysis, relapse occurred less frequently among patients receiving i.v. Bu compared with TBI (relative risk [RR], .36; P=022) or oral Bu (RR, .39; P=028), but nonrelapse mortality and survival were similar. A significant interaction was detected between donor relation and the main effect in leukemia-free survival (LFS). Among recipients of HLA-identical sibling grafts, but not URD grafts, LFS was better in patients receiving i.v. Bu (RR, .53; P=025) or oral Bu (RR, .64; P=017) compared with TBI. In CML in first chronic phase, Cy in combination with i.v. Bu was associated with less relapse than TBI or oral Bu. LFS was better after i.v. or oral Bu compared with TBI.
Bibliographical noteFunding Information:
The CIBMTR is supported by Public Health Service Grant/Cooperative Agreement U24-CA76518 from the National Cancer Institute , the National Heart, Lung, and Blood Institute and the National Institute of Allergy and Infectious Diseases ; a grant/cooperative agreement 5U01HL069294 from NHLBI and NCI ; a contract HHSH234200637015C with Health Resources and Services Administration (HRSA/DHHS); 2 grants N00014-06-1-0704 and N00014-08-1-0058 from the Office of Naval Research ; and grants from Allos, Inc. ; Amgen ; Angioblast ; anonymous donation to the Medical College of Wisconsin; Ariad ; Be The Match Foundation ; Blue Cross and Blue Shield Association ; Buchanan Family Foundation ; CaridianBCT ; Celgene Corporation ; CellGenix GmbH ; Children's Leukemia Research Association ; Fresenius-Biotech North America, Inc. ; Gamida Cell Teva Joint Venture Ltd. ; Genentech, Inc. ; Genzyme Corporation ; GlaxoSmithKline ; Kiadis Pharma ; The Leukemia & Lymphoma Society ; The Medical College of Wisconsin ; Millennium Pharmaceuticals, Inc. ; Milliman USA, Inc. ; Miltenyi Biotec ; National Marrow Donor Program ; Optum Healthcare Solutions, Inc. ; Otsuka America Pharmaceutical, Inc. ; Seattle Genetics ; Sigma-Tau Pharmaceuticals ; Soligenix, Inc. ; Swedish Orphan Biovitrum ; Therakos ; and WellPoint The views expressed in this article do not reflect the official policy or position of the National Institute of Health, the Department of the Navy, the Department of Defense, or any other agency of the US Government.
- Chronic myeloid leukemia
- Total body irradiation