J Korean Med Sci.  2021 May;36(19):e128. 10.3346/jkms.2021.36.e128.

Conditioning with 10 Gy Total Body Irradiation, Cyclophosphamide, and Fludarabine without ATG Is Associated with Improved Outcome of Cord Blood Transplantation in Children with Acute Leukemia

• Cho HW
• Ju HY
• Hyun JK
• Lee Jw
• Sung KW
• Koo HH
• Lim DH
• Yoo KH

• KMID: 2515863
• DOI: http://doi.org/10.3346/jkms.2021.36.e128

Abstract

Background
The optimal conditioning regimen in cord blood transplantation (CBT) needs to be determined. This study aimed to identify the impact of conditioning regimen on the outcome of CBT in children with acute leukemia.
Methods
Medical records of patients with acute leukemia who received CBT were retrospectively reviewed.
Results
A total of 71 patients were allocated into 2 groups; patients who received total body irradiation 10 Gy, cyclophosphamide 120 mg/kg, and fludarabine 75 mg/m 2 were named as the TCF group (n = 18), while the non-TCF group (n = 53) included patients conditioned with regimens other than the TCF regimen. All patients in the TCF group were successfully engrafted, while 22.6% in the non-TCF group (n = 12) failed to achieve donor-origin hematopoiesis (P = 0.028). The incidence of cytomegalovirus diseases was 5.6% in the TCF group and 30.2% in the non-TCF group (P = 0.029). The 5-year overall survival rates of the TCF and non-TCF groups were 77.8% and 44.2%, respectively (P = 0.017).
Conclusion
Patients conditioned with the TCF regimen achieved better engraftment and survival rates, less suffering from cytomegalovirus disease. Our data suggest that the TCF regimen is a preferred option for CBT in children with acute leukemia.

Keyword

Total Body Irradiation; Cyclophosphamide; Fludarabine; Cord Blood Transplantation; Acute Leukemia; Children

Figure

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  Fig. 1 Probabilities of neutrophil recovery.HSCT = hematopoietic stem cell transplantation, TCF = total body irradiation 10 Gy, cyclophosphamide 120 mg/kg, and fludarabine 75 mg/m2.

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  Fig. 2 Comparison of 5-year survival rates of the 2 groups. (A) The 5-year EFS. (B) The 5-year OS.EFS = event-free survival, TCF = total body irradiation 10 Gy, cyclophosphamide 120 mg/kg, and fludarabine 75 mg/m2, OS = overall survival.

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  Fig. 3 The Cumulative incidences of the 5-year relapse and non-relapse mortality.TCF = total body irradiation 10 Gy, cyclophosphamide 120 mg/kg, and fludarabine 75 mg/m2.

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  Fig. 4 The 5-year EFS and OS of the 3-group analysis. (A) The 5-year EFS. (B) The 5-year OS.EFS = event-free survival, TBI = total body irradiation, ATG = anti-thymocyte globulin, OS = overall survival.

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