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Reduced-intensity conditioning with fludarabine and busulfan versus fludarabine and melphalan for patients with acute myeloid leukemia: a report from the Acute Leukemia Working Party of the European Group for Blood and Marrow Transplantation.
Cancer. 2015 Apr 01; 121(7):1048-55.C

Abstract

BACKGROUND

Fludarabine plus busulfan (FB) and fludarabine plus melphalan (FM) are 2 widely used reduced-intensity conditioning (RIC) regimens for allogeneic hematopoietic stem cell transplantation (allo-SCT).

METHODS

The current survey compared transplantation outcomes for a cohort of 394 acute myeloid leukemia (AML) patients given bone marrow or peripheral blood stem cells from human leukocyte antigen-identical siblings after FB (n = 218) or FM (n = 176). Patients given manipulated grafts and those given T-cell-depleting agents (anti-thymocyte globulins or alemtuzumab) were not included.

RESULTS

At the time of transplantation, 266 patients (68%) were experiencing their first complete remission (CR), 69 (18%) were experiencing a later CR, and 59 (15%) had advanced disease. The incidences of acute and chronic graft-versus-host disease were similar in the 2 groups of patients. The 2-year relapse incidence (RI), nonrelapse mortality (NRM) rate, leukemia-free survival (LFS) rate, and overall survival (OS) rate were 31% ± 3%, 18% ± 3%, 51% ± 4%, and 54% ± 4%, respectively, for FB patients and 20% ± 3% (P = .007), 20% ± 3% (P = .4), 60% ± 4% (P = .08), and 62% ± 4% (P = .2), respectively, for FM patients. Among FB patients given intravenous busulfan (n = 81), the 2-year RI, NRM, LFS, and OS rates were 26% ± 5% (P = .43 vs FM patients), 25% ± 6% (P = .18), 49% ± 7% (P = .07), and 54% ± 7% (P = .13), respectively. In multivariate analyses, FM was associated with a lower RI (hazard ratio [HR], 0.5; P = .01) and a trend toward higher NRM (HR, 1.6; P = .1) with similar LFS (HR, 0.8; P = .2) and OS (HR, 0.9; P = .6).

CONCLUSIONS

These results suggest that although FM provides better AML control than FB as an RIC regimen for allo-SCT, the 2 regimens provide similar survival. Multicenter randomized studies are needed to confirm these findings.

Authors+Show Affiliations

Department of Hematology, University of Liege, Liege, Belgium.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

25424330

Citation

Baron, Frédéric, et al. "Reduced-intensity Conditioning With Fludarabine and Busulfan Versus Fludarabine and Melphalan for Patients With Acute Myeloid Leukemia: a Report From the Acute Leukemia Working Party of the European Group for Blood and Marrow Transplantation." Cancer, vol. 121, no. 7, 2015, pp. 1048-55.
Baron F, Labopin M, Peniket A, et al. Reduced-intensity conditioning with fludarabine and busulfan versus fludarabine and melphalan for patients with acute myeloid leukemia: a report from the Acute Leukemia Working Party of the European Group for Blood and Marrow Transplantation. Cancer. 2015;121(7):1048-55.
Baron, F., Labopin, M., Peniket, A., Jindra, P., Afanasyev, B., Sanz, M. A., Deconinck, E., Nagler, A., & Mohty, M. (2015). Reduced-intensity conditioning with fludarabine and busulfan versus fludarabine and melphalan for patients with acute myeloid leukemia: a report from the Acute Leukemia Working Party of the European Group for Blood and Marrow Transplantation. Cancer, 121(7), 1048-55. https://doi.org/10.1002/cncr.29163
Baron F, et al. Reduced-intensity Conditioning With Fludarabine and Busulfan Versus Fludarabine and Melphalan for Patients With Acute Myeloid Leukemia: a Report From the Acute Leukemia Working Party of the European Group for Blood and Marrow Transplantation. Cancer. 2015 Apr 1;121(7):1048-55. PubMed PMID: 25424330.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Reduced-intensity conditioning with fludarabine and busulfan versus fludarabine and melphalan for patients with acute myeloid leukemia: a report from the Acute Leukemia Working Party of the European Group for Blood and Marrow Transplantation. AU - Baron,Frédéric, AU - Labopin,Myriam, AU - Peniket,Andy, AU - Jindra,Pavel, AU - Afanasyev,Boris, AU - Sanz,Miguel A, AU - Deconinck,Eric, AU - Nagler,Arnon, AU - Mohty,Mohamad, Y1 - 2014/11/25/ PY - 2014/09/10/received PY - 2014/10/09/revised PY - 2014/10/13/accepted PY - 2014/11/27/entrez PY - 2014/11/27/pubmed PY - 2015/5/23/medline KW - acute myeloid leukemia (AML) KW - busulfan KW - fludarabine KW - graft-versus-host disease (GVHD) KW - melphalan KW - reduced-intensity conditioning (RIC) KW - transplantation SP - 1048 EP - 55 JF - Cancer JO - Cancer VL - 121 IS - 7 N2 - BACKGROUND: Fludarabine plus busulfan (FB) and fludarabine plus melphalan (FM) are 2 widely used reduced-intensity conditioning (RIC) regimens for allogeneic hematopoietic stem cell transplantation (allo-SCT). METHODS: The current survey compared transplantation outcomes for a cohort of 394 acute myeloid leukemia (AML) patients given bone marrow or peripheral blood stem cells from human leukocyte antigen-identical siblings after FB (n = 218) or FM (n = 176). Patients given manipulated grafts and those given T-cell-depleting agents (anti-thymocyte globulins or alemtuzumab) were not included. RESULTS: At the time of transplantation, 266 patients (68%) were experiencing their first complete remission (CR), 69 (18%) were experiencing a later CR, and 59 (15%) had advanced disease. The incidences of acute and chronic graft-versus-host disease were similar in the 2 groups of patients. The 2-year relapse incidence (RI), nonrelapse mortality (NRM) rate, leukemia-free survival (LFS) rate, and overall survival (OS) rate were 31% ± 3%, 18% ± 3%, 51% ± 4%, and 54% ± 4%, respectively, for FB patients and 20% ± 3% (P = .007), 20% ± 3% (P = .4), 60% ± 4% (P = .08), and 62% ± 4% (P = .2), respectively, for FM patients. Among FB patients given intravenous busulfan (n = 81), the 2-year RI, NRM, LFS, and OS rates were 26% ± 5% (P = .43 vs FM patients), 25% ± 6% (P = .18), 49% ± 7% (P = .07), and 54% ± 7% (P = .13), respectively. In multivariate analyses, FM was associated with a lower RI (hazard ratio [HR], 0.5; P = .01) and a trend toward higher NRM (HR, 1.6; P = .1) with similar LFS (HR, 0.8; P = .2) and OS (HR, 0.9; P = .6). CONCLUSIONS: These results suggest that although FM provides better AML control than FB as an RIC regimen for allo-SCT, the 2 regimens provide similar survival. Multicenter randomized studies are needed to confirm these findings. SN - 1097-0142 UR - https://www.unboundmedicine.com/medline/citation/25424330/Reduced_intensity_conditioning_with_fludarabine_and_busulfan_versus_fludarabine_and_melphalan_for_patients_with_acute_myeloid_leukemia:_a_report_from_the_Acute_Leukemia_Working_Party_of_the_European_Group_for_Blood_and_Marrow_Transplantation_ L2 - https://doi.org/10.1002/cncr.29163 DB - PRIME DP - Unbound Medicine ER -