TY - JOUR
T1 - Myeloablative Reduced-Toxicity i.v. Busulfan-Fludarabine and Allogeneic Hematopoietic Stem Cell Transplant for Patients with Acute Myeloid Leukemia or Myelodysplastic Syndrome in the Sixth through Eighth Decades of Life
AU - Alatrash, Gheath
AU - De Lima, Marcos
AU - Hamerschlak, Nelson
AU - Pelosini, Matteo
AU - Wang, Xuemei
AU - Xiao, Lianchun
AU - Kerbauy, Fabio
AU - Chiattone, Alexandre
AU - Rondon, Gabriela
AU - Qazilbash, Muzaffar H.
AU - Giralt, Sergio A.
AU - De Padua Silva, Leandro
AU - Hosing, Chitra
AU - Kebriaei, Partow
AU - Zhang, Weiqing
AU - Nieto, Yago
AU - Saliba, Rima M.
AU - Champlin, Richard E.
AU - Andersson, Borje S.
N1 - Funding Information:
Salary for Dr. Alatrash at the time this work was conducted was supported in part by the M.D. Anderson Barbara Rattay Advanced Scholars Program. These studies were supported by NIH Grants CA55164 and CA49639 .
PY - 2011/10
Y1 - 2011/10
N2 - The optimal pretransplant regimen for acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS) in patients ≥55 years of age remains to be determined. The myeloablative reduced-toxicity 4-day regimen i.v. busulfan (Bu) (130 mg/m 2) and i.v. fludarabine (Flu) (40 mg/m 2) is associated with low morbidity and mortality. We analyzed 79 patients ≥55 years of age (median, 58 years) with AML (n = 63) or MDS (n = 16) treated with i.v. Bu-Flu conditioning regimens between 2001 and 2009 (median follow-up, 24 months). The patients who received this regimen had a good performance status. The 2-year overall survival (OS) rates for patients in first complete remission (CR1), second CR (CR2), or refractory disease and for all patients at time of transplantation were 71%, 44%, 32%, and 46%, respectively; 2-year event-free survival (EFS) rates for patients in CR1, CR2, or refractory disease at time of transplantation and for all patients were 68%, 42%, 30%, and 44%, respectively. One-year transplant-related mortality (TRM) rates for patients who were in CR or who had active disease at the time of transplantation were 19% and 20%, respectively. Grade II-IV acute graft-versus-host (aGVHD) disease was diagnosed in 40% of the patients. Our results suggest that age alone should not be the primary reason for exclusion from receiving myeloablative reduced-toxicity conditioning with i.v. Bu-Flu preceding transplantation in patients with AML/MDS.
AB - The optimal pretransplant regimen for acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS) in patients ≥55 years of age remains to be determined. The myeloablative reduced-toxicity 4-day regimen i.v. busulfan (Bu) (130 mg/m 2) and i.v. fludarabine (Flu) (40 mg/m 2) is associated with low morbidity and mortality. We analyzed 79 patients ≥55 years of age (median, 58 years) with AML (n = 63) or MDS (n = 16) treated with i.v. Bu-Flu conditioning regimens between 2001 and 2009 (median follow-up, 24 months). The patients who received this regimen had a good performance status. The 2-year overall survival (OS) rates for patients in first complete remission (CR1), second CR (CR2), or refractory disease and for all patients at time of transplantation were 71%, 44%, 32%, and 46%, respectively; 2-year event-free survival (EFS) rates for patients in CR1, CR2, or refractory disease at time of transplantation and for all patients were 68%, 42%, 30%, and 44%, respectively. One-year transplant-related mortality (TRM) rates for patients who were in CR or who had active disease at the time of transplantation were 19% and 20%, respectively. Grade II-IV acute graft-versus-host (aGVHD) disease was diagnosed in 40% of the patients. Our results suggest that age alone should not be the primary reason for exclusion from receiving myeloablative reduced-toxicity conditioning with i.v. Bu-Flu preceding transplantation in patients with AML/MDS.
KW - AML
KW - Busulfan
KW - Elderly
KW - Mds
KW - Preparative regimen
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U2 - 10.1016/j.bbmt.2011.02.007
DO - 10.1016/j.bbmt.2011.02.007
M3 - Article
C2 - 21338705
AN - SCOPUS:80052576601
SN - 1083-8791
VL - 17
SP - 1490
EP - 1496
JO - Biology of Blood and Marrow Transplantation
JF - Biology of Blood and Marrow Transplantation
IS - 10
ER -