1. Reduced intensity conditioning for acute myeloid leukemia using melphalan- vs busulfan-based regimens: a CIBMTR report
- Author
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Michael Byrne, Jane L. Liesveld, Richard F. Olsson, Sagar S. Patel, Hongtao Liu, Eric Wong, Brenda M. Sandmaier, Bipin N. Savani, Hannah Choe, Partow Kebriaei, Gulrayz Ahmed, Tania Jain, Moussab Damlaj, Rebecca L. Olin, Mehdi Hamadani, Uday R. Popat, Neil Palmisiano, Rajneesh Nath, Mei-Jie Zhang, Mark R. Litzow, Attaphol Pawarode, Mark P. Hertzberg, Taiga Nishihori, Arnon Nagler, Jean A. Yared, Mitchell S. Cairo, Ioannis Politikos, Michael R. Grunwald, Hisham Abdel-Azim, Usama Gergis, David A. Rizzieri, Baldeep Wirk, Ashish Bajel, Rammurti T. Kamble, Hemant S. Murthy, Jean-Yves Cahn, Corey Cutler, Mahmoud Aljurf, A. Samer Al-Homsi, Geoffrey L. Uy, Miguel-Angel Perales, Muhammad Waqas Khan, Miguel Angel Diaz, Minocher Battiwalla, Mohamed A. Kharfan-Dabaja, Nosha Farhadfar, Natasha Kekre, Vaibhav Agrawal, Hillard M. Lazarus, Jan Cerny, Rodrigo Martino, Nandita Khera, Youjin Wang, Asmita Mishra, Nasheed Hossain, Luis Isola, Leo F. Verdonck, Nirav N. Shah, Vijaya Raj Bhatt, Zachariah DeFilipp, Daniel J. Weisdorf, Vikram Mathews, Edward A. Copelan, Aaron T. Gerds, C. Esar O. Freytes, David Valc A. Arcel, Shahrukh K. Hashmi, Mrinal M. Patnaik, Sunita Nathan, Sachiko Seo, Marcos de Lima, Qaiser Bashir, David I. Marks, Zheng Zhou, Yoshihiro Inamoto, Ryotaro Nakamura, Hai-Lin Wang, Edmund K. Waller, James M. Foran, Gerhard C. Hildebrandt, Amer Assal, Zartash Gul, Hassan B. Alkhateeb, Ulrike Bacher, and Wael Saber
- Subjects
Adult ,Melphalan ,medicine.medical_specialty ,Transplantation Conditioning ,medicine.medical_treatment ,Hematopoietic stem cell transplantation ,Gastroenterology ,hemic and lymphatic diseases ,Internal medicine ,medicine ,Humans ,610 Medicine & health ,Busulfan ,business.industry ,Hematopoietic Stem Cell Transplantation ,Hematology ,Total body irradiation ,medicine.disease ,Fludarabine ,Transplantation ,Leukemia, Myeloid, Acute ,Leukemia ,Alemtuzumab ,Erratum ,business ,medicine.drug - Abstract
There is a lack of large comparative study on the outcomes of reduced intensity conditioning (RIC) in acute myeloid leukemia (AML) transplantation using fludarabine/busulfan (FB) and fludarabine/melphalan (FM) regimens. Adult AML patients from Center for International Blood and Marrow Transplant Research who received first RIC allo-transplant between 2001 and 2015 were studied. Patients were excluded if they received cord blood or identical twin transplant, total body irradiation in conditioning, or graft-versus-host disease (GVHD) prophylaxis with in vitro T-cell depletion. Primary outcome was overall survival (OS), secondary end points were leukemia-free survival (LFS), nonrelapse mortality (NRM), relapse, and GVHD. Multivariate survival model was used with adjustment for patient, leukemia, and transplant-related factors. A total of 622 patients received FM and 791 received FB RIC. Compared with FB, the FM group had fewer transplant in complete remission (CR), fewer matched sibling donors, and less usage of anti-thymocyte globulin or alemtuzumab. More patients in the FM group received marrow grafts and had transplantation before 2005. OS was significantly lower within the first 3 months posttransplant in the FM group (hazard ratio [HR] = 1.82, P < .001), but was marginally superior beyond 3 months (HR = 0.87, P = .05). LFS was better with FM compared with FB (HR = 0.89, P = .05). NRM was significantly increased in the FM group during the first 3 months of posttransplant (HR = 3.85, P < .001). Long-term relapse was lower with FM (HR = 0.65, P < .001). Analysis restricted to patients with CR showed comparable results. In conclusion, compared with FB, the FM RIC showed a marginally superior long-term OS and LFS and a lower relapse rate. A lower OS early posttransplant within 3 months was largely the result of a higher early NRM.
- Published
- 2020