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 -