Intensified conditioning containing decitabine versus standard myeloablative conditioning for adult patients with KMT2A-rearranged leukemia: a multicenter retrospective study
Abstract Background Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is recommended for patients with KMT2A-rearranged (KMT2A-r) leukemia whereas relapse remains high. We aimed to determine whether intensified conditioning containing decitabine (Dec) could reduce relapse compared with...
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2024-12-01
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| author | Zhongli Hu Zinan Feng Shiqi Liu Hai He Ying Dong Zhiping Fan Yiqing Li Fen Huang Na Xu Can Liu Yunxin Zeng Ping Zhu Ren Lin Hua Jin Xiong Zhang Ruijuan Sun Qifa Liu Li Xuan |
| author_facet | Zhongli Hu Zinan Feng Shiqi Liu Hai He Ying Dong Zhiping Fan Yiqing Li Fen Huang Na Xu Can Liu Yunxin Zeng Ping Zhu Ren Lin Hua Jin Xiong Zhang Ruijuan Sun Qifa Liu Li Xuan |
| author_sort | Zhongli Hu |
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| description | Abstract Background Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is recommended for patients with KMT2A-rearranged (KMT2A-r) leukemia whereas relapse remains high. We aimed to determine whether intensified conditioning containing decitabine (Dec) could reduce relapse compared with standard myeloablative conditioning in adult patients with KMT2A-r leukemia. Methods We performed a multicenter retrospective study at seven institutions in China. Eligible patients were aged 14 years or older at transplantation, had a diagnosis of KMT2A-r leukemia, and underwent the first allo-HSCT. Standard myeloablative conditioning regimens (standard group) included BuCy (busulfan 3.2 mg/kg/day on days -7 to -4; cyclophosphamide 60 mg/kg/day on days -3 to -2) and TBI-Cy (total body irradiation 4.5 Gy/day on days -5 to -4; Cy 60 mg/kg/day on days -3 to -2). Intensified conditioning regimens containing Dec (intensified group) consisted of Dec-BuCy (Dec 20 mg/m2/day on days -14 to -10; the same dose of BuCy) and Dec-TBI-Cy (Dec 20 mg/m2/day on days -10 to -6; the same dose of TBI-Cy). Results Between April 2009 and December 2019, 218 patients were included in this study, of whom 105 were in the intensified group and 113 were in the standard group. The 3-year cumulative incidence of relapse was 17.6% and 34.5%, overall survival was 71.3% and 61.0%, disease-free survival was 70.1% and 56.0%, and non-relapse mortality was 12.3% and 9.5% in the intensified and standard groups, respectively (P = 0.001; P = 0.034; P = 0.005; P = 0.629). Subgroup analysis showed that the relapse rate of intensified conditioning was lower than that of standard conditioning in multiple subgroups, including different leukemia types, disease status at transplantation, high-risk cytogenetics and Bu-based regimens. There was no difference in regimen-related toxicity, engraftment, or graft-versus-host disease between the intensified and standard groups. Conclusions These results suggest that intensified conditioning containing Dec might be a better strategy than standard myeloablative conditioning for adult patients with KMT2A-r leukemia undergoing allo-HSCT. |
| format | Article |
| id | doaj-art-fb16ca765ad64205b0cbaa938cc21612 |
| institution | Kabale University |
| issn | 1741-7015 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | BMC |
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| series | BMC Medicine |
| spelling | doaj-art-fb16ca765ad64205b0cbaa938cc216122025-01-05T12:32:54ZengBMCBMC Medicine1741-70152024-12-0122111110.1186/s12916-024-03830-0Intensified conditioning containing decitabine versus standard myeloablative conditioning for adult patients with KMT2A-rearranged leukemia: a multicenter retrospective studyZhongli Hu0Zinan Feng1Shiqi Liu2Hai He3Ying Dong4Zhiping Fan5Yiqing Li6Fen Huang7Na Xu8Can Liu9Yunxin Zeng10Ping Zhu11Ren Lin12Hua Jin13Xiong Zhang14Ruijuan Sun15Qifa Liu16Li Xuan17Department of Hematology, Nanfang Hospital, Southern Medical UniversityDepartment of Hematology, Nanfang Hospital, Southern Medical UniversityDepartment of Hematology, Nanfang Hospital, Southern Medical UniversityDepartment of Bone Marrow Transplantation, Hebei Yanda Lu Daopei HospitalDepartment of Hematology, Maoming People’s HospitalDepartment of Hematology, Nanfang Hospital, Southern Medical UniversityDepartment of Hematology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen UniversityDepartment of Hematology, Nanfang Hospital, Southern Medical UniversityDepartment of Hematology, Nanfang Hospital, Southern Medical UniversityDepartment of Hematology, Hunan Provincial People’s HospitalDepartment of Hematology, the Seventh Affiliated Hospital of Sun Yat-Sen UniversityDepartment of Hematology, the First People Hospital of ChenzhouDepartment of Hematology, Nanfang Hospital, Southern Medical UniversityDepartment of Hematology, Nanfang Hospital, Southern Medical UniversityDepartment of Hematology, Maoming People’s HospitalDepartment of Bone Marrow Transplantation, Hebei Yanda Lu Daopei HospitalDepartment of Hematology, Nanfang Hospital, Southern Medical UniversityDepartment of Hematology, Nanfang Hospital, Southern Medical UniversityAbstract Background Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is recommended for patients with KMT2A-rearranged (KMT2A-r) leukemia whereas relapse remains high. We aimed to determine whether intensified conditioning containing decitabine (Dec) could reduce relapse compared with standard myeloablative conditioning in adult patients with KMT2A-r leukemia. Methods We performed a multicenter retrospective study at seven institutions in China. Eligible patients were aged 14 years or older at transplantation, had a diagnosis of KMT2A-r leukemia, and underwent the first allo-HSCT. Standard myeloablative conditioning regimens (standard group) included BuCy (busulfan 3.2 mg/kg/day on days -7 to -4; cyclophosphamide 60 mg/kg/day on days -3 to -2) and TBI-Cy (total body irradiation 4.5 Gy/day on days -5 to -4; Cy 60 mg/kg/day on days -3 to -2). Intensified conditioning regimens containing Dec (intensified group) consisted of Dec-BuCy (Dec 20 mg/m2/day on days -14 to -10; the same dose of BuCy) and Dec-TBI-Cy (Dec 20 mg/m2/day on days -10 to -6; the same dose of TBI-Cy). Results Between April 2009 and December 2019, 218 patients were included in this study, of whom 105 were in the intensified group and 113 were in the standard group. The 3-year cumulative incidence of relapse was 17.6% and 34.5%, overall survival was 71.3% and 61.0%, disease-free survival was 70.1% and 56.0%, and non-relapse mortality was 12.3% and 9.5% in the intensified and standard groups, respectively (P = 0.001; P = 0.034; P = 0.005; P = 0.629). Subgroup analysis showed that the relapse rate of intensified conditioning was lower than that of standard conditioning in multiple subgroups, including different leukemia types, disease status at transplantation, high-risk cytogenetics and Bu-based regimens. There was no difference in regimen-related toxicity, engraftment, or graft-versus-host disease between the intensified and standard groups. Conclusions These results suggest that intensified conditioning containing Dec might be a better strategy than standard myeloablative conditioning for adult patients with KMT2A-r leukemia undergoing allo-HSCT.https://doi.org/10.1186/s12916-024-03830-0DecitabineIntensified conditioningAllo-HSCTKMT2A-r leukemia |
| spellingShingle | Zhongli Hu Zinan Feng Shiqi Liu Hai He Ying Dong Zhiping Fan Yiqing Li Fen Huang Na Xu Can Liu Yunxin Zeng Ping Zhu Ren Lin Hua Jin Xiong Zhang Ruijuan Sun Qifa Liu Li Xuan Intensified conditioning containing decitabine versus standard myeloablative conditioning for adult patients with KMT2A-rearranged leukemia: a multicenter retrospective study BMC Medicine Decitabine Intensified conditioning Allo-HSCT KMT2A-r leukemia |
| title | Intensified conditioning containing decitabine versus standard myeloablative conditioning for adult patients with KMT2A-rearranged leukemia: a multicenter retrospective study |
| title_full | Intensified conditioning containing decitabine versus standard myeloablative conditioning for adult patients with KMT2A-rearranged leukemia: a multicenter retrospective study |
| title_fullStr | Intensified conditioning containing decitabine versus standard myeloablative conditioning for adult patients with KMT2A-rearranged leukemia: a multicenter retrospective study |
| title_full_unstemmed | Intensified conditioning containing decitabine versus standard myeloablative conditioning for adult patients with KMT2A-rearranged leukemia: a multicenter retrospective study |
| title_short | Intensified conditioning containing decitabine versus standard myeloablative conditioning for adult patients with KMT2A-rearranged leukemia: a multicenter retrospective study |
| title_sort | intensified conditioning containing decitabine versus standard myeloablative conditioning for adult patients with kmt2a rearranged leukemia a multicenter retrospective study |
| topic | Decitabine Intensified conditioning Allo-HSCT KMT2A-r leukemia |
| url | https://doi.org/10.1186/s12916-024-03830-0 |
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