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Reduced-intensity stem cell transplantation for acute myeloid leukemia with fludarabine-based conditioning with intravenous busulfan versus melphalan.
Bone Marrow Transplant. 2020 Oct; 55(10):1955-1965.BM

Abstract

Reduced-intensity conditioning (RIC) has been facilitating allogeneic hematopoietic cell transplantation (allo-HCT) for patients originally considered ineligible for HCT with myeloablative conditioning. Fludarabine (Flu) with reduced doses of busulfan (Bu) (Flu + Bu) and Flu with reduced doses of melphalan (Mel) (Flu + Mel) are widely used RIC regimens for acute myeloid leukemia (AML). A nationwide retrospective study comparing clinical outcomes of adult patients with AML receiving first allo-HCT after RIC between 2001 and 2010 was performed. Cumulative incidences of relapse were not significantly different among the Flu + ivBu-based (FBiv), Flu + poBu-based (FBpo), and Flu + Mel-based (FM) groups (p = 0.29). Non-relapse mortality (NRM) was significantly lower in patients receiving FBiv compared with FBpo (p = 0.003) and FM (p < 0.001). On multivariate analysis, there was no significant difference in overall survival, but FM was associated with a significantly lower risk of relapse (hazard ratio (HR) = 0.65, 95% confidence interval (CI): 0.50-0.85, p = 0.002), higher NRM (HR = 1.60, 95% CI: 1.10-2.33, p = 0.013) and better leukemia-free survival (HR = 0.77, 95% CI: 0.63-0.95, p = 0.015) compared with FBiv. These results suggest that Flu + Mel has a more intense disease control potential and Flu + ivBu is less toxic than the other. Both RIC regimens provide similar survival outcomes and are effective and useful regimens for patients with AML who received allo-HCT.

Authors+Show Affiliations

Department of Hematology, St. Luke's International Hospital, Tokyo, Japan. tayamash@luke.ac.jp.Division of Hematology, Department of Internal Medicine, Aichi Medical University Hospital, Aichi, Japan.Department of Hematology, Federation of National Public Service Personnel Mutual Aid Associations Toranomon Hospital, Tokyo, Japan.Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan.Department of Hematology, Hamanomachi Hospital, Fukuoka, Japan.Department of Hematology, Hokkaido University Hospital, Sapporo, Japan.Department of Hematology, Sapporo Hokuyu Hospital, Sapporo, Japan.Department of Hematology, Tenri Hospital, Tenri, Japan.Department of Hematology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan.Department of Hematology, Kyoto University Hospital, Kyoto, Japan.Department of Hematology, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan.Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan. Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan.Department of Clinical Oncology and Hematology, The Jikei University School of Medicine, Tokyo, Japan.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32203256

Citation

Yamashita, Takuya, et al. "Reduced-intensity Stem Cell Transplantation for Acute Myeloid Leukemia With Fludarabine-based Conditioning With Intravenous Busulfan Versus Melphalan." Bone Marrow Transplantation, vol. 55, no. 10, 2020, pp. 1955-1965.
Yamashita T, Takami A, Uchida N, et al. Reduced-intensity stem cell transplantation for acute myeloid leukemia with fludarabine-based conditioning with intravenous busulfan versus melphalan. Bone Marrow Transplant. 2020;55(10):1955-1965.
Yamashita, T., Takami, A., Uchida, N., Fukuda, T., Eto, T., Shiratori, S., Ota, S., Akasaka, T., Miyakoshi, S., Kondo, T., Hidaka, M., Kanda, J., Atsuta, Y., & Yano, S. (2020). Reduced-intensity stem cell transplantation for acute myeloid leukemia with fludarabine-based conditioning with intravenous busulfan versus melphalan. Bone Marrow Transplantation, 55(10), 1955-1965. https://doi.org/10.1038/s41409-020-0856-y
Yamashita T, et al. Reduced-intensity Stem Cell Transplantation for Acute Myeloid Leukemia With Fludarabine-based Conditioning With Intravenous Busulfan Versus Melphalan. Bone Marrow Transplant. 2020;55(10):1955-1965. PubMed PMID: 32203256.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Reduced-intensity stem cell transplantation for acute myeloid leukemia with fludarabine-based conditioning with intravenous busulfan versus melphalan. AU - Yamashita,Takuya, AU - Takami,Akiyoshi, AU - Uchida,Naoyuki, AU - Fukuda,Takahiro, AU - Eto,Tetsuya, AU - Shiratori,Souichi, AU - Ota,Shuichi, AU - Akasaka,Takashi, AU - Miyakoshi,Shigesaburo, AU - Kondo,Tadakazu, AU - Hidaka,Michihiro, AU - Kanda,Junya, AU - Atsuta,Yoshiko, AU - Yano,Shingo, Y1 - 2020/03/12/ PY - 2018/09/10/received PY - 2020/03/02/accepted PY - 2020/03/01/revised PY - 2020/3/24/pubmed PY - 2020/3/24/medline PY - 2020/3/24/entrez SP - 1955 EP - 1965 JF - Bone marrow transplantation JO - Bone Marrow Transplant. VL - 55 IS - 10 N2 - Reduced-intensity conditioning (RIC) has been facilitating allogeneic hematopoietic cell transplantation (allo-HCT) for patients originally considered ineligible for HCT with myeloablative conditioning. Fludarabine (Flu) with reduced doses of busulfan (Bu) (Flu + Bu) and Flu with reduced doses of melphalan (Mel) (Flu + Mel) are widely used RIC regimens for acute myeloid leukemia (AML). A nationwide retrospective study comparing clinical outcomes of adult patients with AML receiving first allo-HCT after RIC between 2001 and 2010 was performed. Cumulative incidences of relapse were not significantly different among the Flu + ivBu-based (FBiv), Flu + poBu-based (FBpo), and Flu + Mel-based (FM) groups (p = 0.29). Non-relapse mortality (NRM) was significantly lower in patients receiving FBiv compared with FBpo (p = 0.003) and FM (p < 0.001). On multivariate analysis, there was no significant difference in overall survival, but FM was associated with a significantly lower risk of relapse (hazard ratio (HR) = 0.65, 95% confidence interval (CI): 0.50-0.85, p = 0.002), higher NRM (HR = 1.60, 95% CI: 1.10-2.33, p = 0.013) and better leukemia-free survival (HR = 0.77, 95% CI: 0.63-0.95, p = 0.015) compared with FBiv. These results suggest that Flu + Mel has a more intense disease control potential and Flu + ivBu is less toxic than the other. Both RIC regimens provide similar survival outcomes and are effective and useful regimens for patients with AML who received allo-HCT. SN - 1476-5365 UR - https://www.unboundmedicine.com/medline/citation/32203256/Reduced_intensity_stem_cell_transplantation_for_acute_myeloid_leukemia_with_fludarabine_based_conditioning_with_intravenous_busulfan_versus_melphalan_ L2 - https://doi.org/10.1038/s41409-020-0856-y DB - PRIME DP - Unbound Medicine ER -
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