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Thiotepa, busulfan and fludarabine compared to busulfan and cyclophosphamide as conditioning regimen for allogeneic stem cell transplant from matched siblings and unrelated donors for acute myeloid leukemia.
Am J Hematol. 2018 10; 93(10):1211-1219.AJ

Abstract

Busulfan plus cyclophosphamide (BuCy) is the traditional conditioning regimen for allogeneic stem cell transplant (allo-SCT) for young, fit patients with acute myeloid leukemia (AML). The thiotepa-busulfan-fludarabine (TBF) protocol has recently demonstrated promising outcome in cord blood and haploidentical SCT; however, there is limited evidence about this regimen in transplant from matched siblings (MSD) and unrelated donors (UD). We retrospectively compared outcomes of 2523 patients aged 18-50 with AML in remission, undergoing transplant from MSD or UD prepared with either TBF or BuCy conditioning. A 1:3 pair-matched analysis was performed: 146 patients receiving TBF were compared with 438 patients receiving BuCy. Relapse risk was significantly lower in the TBF when compared with BuCy group (HR 0.6, P = .02), while NRM did not differ. No significant difference was observed in LFS and OS between the two regimens. TBF was associated with a trend towards higher risk of grades III-IV aGVHD (HR 1.8, P = .06) and inferior cGVHD (HR 0.7, P = .04) when compared with BuCy. In patients undergoing transplant in first remission, the advantage for TBF in terms of relapse was more evident (HR 0.4, P = .02), leading to a trend for better LFS in favor of TBF (HR 0.7, P = .10), while OS did not differ between the two cohorts. In conclusion, TBF represents a valid myeloablative conditioning regimen providing significantly lower relapse and similar survival when compared with BuCy. Patients in first remission appear to gain the most from this protocol, as in this subgroup a tendency for better LFS was observed when compared with BuCy.

Authors+Show Affiliations

Hematology and Stem Cell Transplant, Romagna Transplant Network, Ravenna, Italy.EBMT Paris Study Office, Saint Antoine Hospital, Paris, France.EBMT Paris Study Office, Saint Antoine Hospital, Paris, France.Tor Vergata University of Rome, Stem Cell Transplant Unit, Policlinico Universitario Tor Vergata, Rome, Italy.Bologna University, S. Orsola-Malpighi Hospital, Institute of Hematology L and A Seràgnoli, Bologna, Italy.Department of Bone Marrow Transplantation, Hadassah University Hospital, Jerusalem, Israel.King Faisal Specialist Hospital and Research Centre, Oncology (Section of Adult Haematolgy/BMT), Riyadh, Saudi Arabia.S.S.C.V.D Trapianto di Cellule Staminali, A.O.U Citta della Salute e della Scienza di Torino, Torino, Italy.Ospedale San Gerardo, Clinica Ematologica dell'Universita Milano-Bicocca, Monza, Italy.Department of Hematology, University Hospital, Basel, Switzerland.Department of Hematology, BMT, Hospital St. Louis, Paris, France.Ospedale Civile, Dipartimento di Ematologia, Medicina Trasfusionale e Biotecnologie, Pescara, Italy.CHU de Lille, LIRIC, INSEM U995, Université Lille 2, Lille, France.Hematology and Stem Cell Transplant, Romagna Transplant Network, Ravenna, Italy.Vanderbilt University Medical Center, Nashville, Tennessee.Department of Haematology, Saint Antoine Hospital, Paris, France.EBMT Paris Study Office, Saint Antoine Hospital, Paris, France. Department of Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel-Hashomer, Israel.No affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

30033639

Citation

Saraceni, Francesco, et al. "Thiotepa, Busulfan and Fludarabine Compared to Busulfan and Cyclophosphamide as Conditioning Regimen for Allogeneic Stem Cell Transplant From Matched Siblings and Unrelated Donors for Acute Myeloid Leukemia." American Journal of Hematology, vol. 93, no. 10, 2018, pp. 1211-1219.
Saraceni F, Beohou E, Labopin M, et al. Thiotepa, busulfan and fludarabine compared to busulfan and cyclophosphamide as conditioning regimen for allogeneic stem cell transplant from matched siblings and unrelated donors for acute myeloid leukemia. Am J Hematol. 2018;93(10):1211-1219.
Saraceni, F., Beohou, E., Labopin, M., Arcese, W., Bonifazi, F., Stepensky, P., Aljurf, M., Bruno, B., Pioltelli, P., Passweg, J., Sociè, G., Santarone, S., Yakoub-Agha, I., Lanza, F., Savani, B. N., Mohty, M., & Nagler, A. (2018). Thiotepa, busulfan and fludarabine compared to busulfan and cyclophosphamide as conditioning regimen for allogeneic stem cell transplant from matched siblings and unrelated donors for acute myeloid leukemia. American Journal of Hematology, 93(10), 1211-1219. https://doi.org/10.1002/ajh.25225
Saraceni F, et al. Thiotepa, Busulfan and Fludarabine Compared to Busulfan and Cyclophosphamide as Conditioning Regimen for Allogeneic Stem Cell Transplant From Matched Siblings and Unrelated Donors for Acute Myeloid Leukemia. Am J Hematol. 2018;93(10):1211-1219. PubMed PMID: 30033639.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Thiotepa, busulfan and fludarabine compared to busulfan and cyclophosphamide as conditioning regimen for allogeneic stem cell transplant from matched siblings and unrelated donors for acute myeloid leukemia. AU - Saraceni,Francesco, AU - Beohou,Eric, AU - Labopin,Myriam, AU - Arcese,William, AU - Bonifazi,Francesca, AU - Stepensky,Polina, AU - Aljurf,Mahmoud, AU - Bruno,Benedetto, AU - Pioltelli,Pietro, AU - Passweg,Jakob, AU - Sociè,Gerard, AU - Santarone,Stella, AU - Yakoub-Agha,Ibrahim, AU - Lanza,Francesco, AU - Savani,Bipin N, AU - Mohty,Mohamad, AU - Nagler,Arnon, AU - ,, Y1 - 2018/08/15/ PY - 2018/05/28/received PY - 2018/07/11/revised PY - 2018/07/16/accepted PY - 2018/7/24/pubmed PY - 2019/6/30/medline PY - 2018/7/24/entrez SP - 1211 EP - 1219 JF - American journal of hematology JO - Am. J. Hematol. VL - 93 IS - 10 N2 - Busulfan plus cyclophosphamide (BuCy) is the traditional conditioning regimen for allogeneic stem cell transplant (allo-SCT) for young, fit patients with acute myeloid leukemia (AML). The thiotepa-busulfan-fludarabine (TBF) protocol has recently demonstrated promising outcome in cord blood and haploidentical SCT; however, there is limited evidence about this regimen in transplant from matched siblings (MSD) and unrelated donors (UD). We retrospectively compared outcomes of 2523 patients aged 18-50 with AML in remission, undergoing transplant from MSD or UD prepared with either TBF or BuCy conditioning. A 1:3 pair-matched analysis was performed: 146 patients receiving TBF were compared with 438 patients receiving BuCy. Relapse risk was significantly lower in the TBF when compared with BuCy group (HR 0.6, P = .02), while NRM did not differ. No significant difference was observed in LFS and OS between the two regimens. TBF was associated with a trend towards higher risk of grades III-IV aGVHD (HR 1.8, P = .06) and inferior cGVHD (HR 0.7, P = .04) when compared with BuCy. In patients undergoing transplant in first remission, the advantage for TBF in terms of relapse was more evident (HR 0.4, P = .02), leading to a trend for better LFS in favor of TBF (HR 0.7, P = .10), while OS did not differ between the two cohorts. In conclusion, TBF represents a valid myeloablative conditioning regimen providing significantly lower relapse and similar survival when compared with BuCy. Patients in first remission appear to gain the most from this protocol, as in this subgroup a tendency for better LFS was observed when compared with BuCy. SN - 1096-8652 UR - https://www.unboundmedicine.com/medline/citation/30033639/Thiotepa_busulfan_and_fludarabine_compared_to_busulfan_and_cyclophosphamide_as_conditioning_regimen_for_allogeneic_stem_cell_transplant_from_matched_siblings_and_unrelated_donors_for_acute_myeloid_leukemia_ L2 - https://doi.org/10.1002/ajh.25225 DB - PRIME DP - Unbound Medicine ER -