タナカ ジユンジ   TANAKA Junji
  田中 淳司
   所属   医学部 医学科(東京女子医科大学病院)
   職種   教授・基幹分野長
論文種別 原著
言語種別 英語
査読の有無 査読あり
表題 Improved prognosis with additional medium-dose VP16 to CY/TBI in allogeneic transplantation for high risk ALL in adults.
掲載誌名 正式名:American journal of hematology
略  称:Am J Hematol
ISSNコード:(1096-8652)0361-8609(Linking)
掲載区分国外
巻・号・頁 93(1),pp.47-57
著者・共著者 Arai Yasuyuki†, Kondo Tadakazu, Shigematsu Akio, Tanaka Junji, Ohashi Kazuteru, Fukuda Takahiro, Hidaka Michihiro, Kobayashi Naoki, Iwato Koji, Sakura Toru, Onizuka Makoto, Ozawa Yukiyasu, Eto Tetsuya, Kurokawa Mineo, Kahata Kaoru, Uchida Naoyuki, Atsuta Yoshiko, Mizuta Shuichi, Kako Shinichi
発行年月 2018/01
概要 Allogeneic hematopoietic stem cell transplantation (HSCT) with the conventional cyclophosphamide and total body irradiation (CY/TBI) regimen is an essential therapeutic strategy for acute lymphoblastic leukemia (ALL) in adults. Medium-dose etoposide (VP16, 30-40 mg/kg) can be added to intensify this CY/TBI regimen and reduce relapse; however, differences in prognosis between the VP16/CY/TBI and CY/TBI regimens have not yet been fully analyzed. We conducted a retrospective cohort study using a Japanese transplant registry database to compare the prognosis between the VP16/CY/TBI (VP16, total 30-40 mg/kg) (N = 376) and CY/TBI (N = 1178) regimens in adult patients with ALL transplanted at complete remission (CR) between January 1, 2000 and December 31, 2014. Our analyses indicated that VP16/CY/TBI significantly reduced relapse compared with CY/TBI (risk ratio, 0.75; 95% confidence interval [CI], 0.56-1.00; P = .05) with a corresponding improvement in leukemia-free survival (hazard ratio [HR], 0.76; 95%CI, 0.62-0.93; P = .01), particularly in patients transplanted at CR1 with advanced-risk (positive minimal residual disease, presence of poor-risk cytogenetics, or an initial elevated leukocyte count) (HR, 0.75; 95%CI, 0.56-1.00; P = .05) or those transplanted beyond CR2 (HR, 0.58; 95%CI, 0.39-0.88; P = .01). The addition of VP16 did not increase post-transplant complications or nonrelapse mortality (HR, 0.88; 95%CI, 0.65-1.18; P = .38). This study is the first to reveal the efficacy of the addition of medium-dose VP16 to CY/TBI in high-risk ALL. To establish new myeloablative conditioning regimens including VP16, a large-scale prospective study is necessary.
DOI 10.1002/ajh.24933
PMID 28983949