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Myeloablative busulfan/cytoxan conditioning versus reduced-intensity fludarabine/melphalan conditioning for allogeneic hematopoietic stem cell transplant in patients with acute myelogenous leukemia.
Leuk Lymphoma. 2018 04; 59(4):837-843.LL

Abstract

Fludarabine and melphalan (Flu/Mel) has emerged as a more tolerable chemotherapy-based conditioning regimen compared with busulfan and cyclophosphamide (Bu/Cy) for allogeneic stem cell transplant (allo-hematopoietic stem cell transplantation (HSCT)) patients with acute myelogenous leukemia (AML). We conducted a retrospective review of a single-institution database including patients with AML who received allo-HSCT following conditioning with Mel/Flu or Bu/Cy-based regimens. We performed descriptive statistical analysis to examine patient demographics and clinical outcomes. We identified 156 patients meeting criteria between 2005 and 2014. Overall, patients conditioned with Bu/Cy were significantly younger, but more likely to be treated in an earlier era than those receiving Flu/Mel. Regimen choice was not associated with relapse rates (RR), relapse-free survival (RFS), or overall survival (OS) on both univariate and multivariable analyses. Bu/Cy was associated with increased non-relapse mortality (NRM) on multivariable analysis. These findings demonstrate that Flu/Mel provides non-inferior disease control and could be an appropriate regimen for selected patients.

Authors+Show Affiliations

a Department of Radiation Oncology , Emory University School of Medicine , Atlanta , GA , USA.a Department of Radiation Oncology , Emory University School of Medicine , Atlanta , GA , USA.b Department of Hematology and Medical Oncology , Winship Cancer Institute at Emory University , Atlanta , GA , USA.b Department of Hematology and Medical Oncology , Winship Cancer Institute at Emory University , Atlanta , GA , USA.b Department of Hematology and Medical Oncology , Winship Cancer Institute at Emory University , Atlanta , GA , USA.a Department of Radiation Oncology , Emory University School of Medicine , Atlanta , GA , USA.c Department of Biostatistics and Bioinformatics , Winship Cancer Institute at Emory University , Atlanta , GA , USA.a Department of Radiation Oncology , Emory University School of Medicine , Atlanta , GA , USA.a Department of Radiation Oncology , Emory University School of Medicine , Atlanta , GA , USA.

Pub Type(s)

Comparative Study
Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

28782395

Citation

Dhere, Vishal, et al. "Myeloablative Busulfan/cytoxan Conditioning Versus Reduced-intensity Fludarabine/melphalan Conditioning for Allogeneic Hematopoietic Stem Cell Transplant in Patients With Acute Myelogenous Leukemia." Leukemia & Lymphoma, vol. 59, no. 4, 2018, pp. 837-843.
Dhere V, Edelman S, Waller EK, et al. Myeloablative busulfan/cytoxan conditioning versus reduced-intensity fludarabine/melphalan conditioning for allogeneic hematopoietic stem cell transplant in patients with acute myelogenous leukemia. Leuk Lymphoma. 2018;59(4):837-843.
Dhere, V., Edelman, S., Waller, E. K., Langston, A., Graiser, M., Connolly, E. C., Switchenko, J. M., Esiashvili, N., & Khan, M. K. (2018). Myeloablative busulfan/cytoxan conditioning versus reduced-intensity fludarabine/melphalan conditioning for allogeneic hematopoietic stem cell transplant in patients with acute myelogenous leukemia. Leukemia & Lymphoma, 59(4), 837-843. https://doi.org/10.1080/10428194.2017.1361027
Dhere V, et al. Myeloablative Busulfan/cytoxan Conditioning Versus Reduced-intensity Fludarabine/melphalan Conditioning for Allogeneic Hematopoietic Stem Cell Transplant in Patients With Acute Myelogenous Leukemia. Leuk Lymphoma. 2018;59(4):837-843. PubMed PMID: 28782395.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Myeloablative busulfan/cytoxan conditioning versus reduced-intensity fludarabine/melphalan conditioning for allogeneic hematopoietic stem cell transplant in patients with acute myelogenous leukemia. AU - Dhere,Vishal, AU - Edelman,Scott, AU - Waller,Edmund K, AU - Langston,Amelia, AU - Graiser,Michael, AU - Connolly,Erin C, AU - Switchenko,Jeffrey M, AU - Esiashvili,Natia, AU - Khan,Mohammad K, Y1 - 2017/08/07/ PY - 2017/8/8/pubmed PY - 2017/8/8/medline PY - 2017/8/8/entrez KW - Transplant toxicity KW - chemotherapeutic approaches KW - myeloid leukemias and dysplasias SP - 837 EP - 843 JF - Leukemia & lymphoma JO - Leuk. Lymphoma VL - 59 IS - 4 N2 - Fludarabine and melphalan (Flu/Mel) has emerged as a more tolerable chemotherapy-based conditioning regimen compared with busulfan and cyclophosphamide (Bu/Cy) for allogeneic stem cell transplant (allo-hematopoietic stem cell transplantation (HSCT)) patients with acute myelogenous leukemia (AML). We conducted a retrospective review of a single-institution database including patients with AML who received allo-HSCT following conditioning with Mel/Flu or Bu/Cy-based regimens. We performed descriptive statistical analysis to examine patient demographics and clinical outcomes. We identified 156 patients meeting criteria between 2005 and 2014. Overall, patients conditioned with Bu/Cy were significantly younger, but more likely to be treated in an earlier era than those receiving Flu/Mel. Regimen choice was not associated with relapse rates (RR), relapse-free survival (RFS), or overall survival (OS) on both univariate and multivariable analyses. Bu/Cy was associated with increased non-relapse mortality (NRM) on multivariable analysis. These findings demonstrate that Flu/Mel provides non-inferior disease control and could be an appropriate regimen for selected patients. SN - 1029-2403 UR - https://www.unboundmedicine.com/medline/citation/28782395/Myeloablative_busulfan/cytoxan_conditioning_versus_reduced_intensity_fludarabine/melphalan_conditioning_for_allogeneic_hematopoietic_stem_cell_transplant_in_patients_with_acute_myelogenous_leukemia_ L2 - http://www.tandfonline.com/doi/full/10.1080/10428194.2017.1361027 DB - PRIME DP - Unbound Medicine ER -