TY - JOUR
T1 - Once Daily i.v. Busulfan and Fludarabine (i.v. Bu-Flu) Compares Favorably with i.v. Busulfan and Cyclophosphamide (i.v. BuCy2) as Pretransplant Conditioning Therapy in AML/MDS
AU - Andersson, Borje S.
AU - de Lima, Marcos
AU - Thall, Peter F.
AU - Wang, Xuemei
AU - Couriel, Daniel
AU - Korbling, Martin
AU - Roberson, Soonja
AU - Giralt, Sergio
AU - Pierre, Betty
AU - Russell, James A.
AU - Shpall, Elizabeth J.
AU - Jones, Roy B.
AU - Champlin, Richard E.
N1 - Funding Information:
This work was supported by National Institutes of Health Grants 2PO1 CA55164 and 2P30CA16672-26, and the Stephen L. and Lavinia P. Boyd Fund for Leukemia Research. The authors are greatly indebted to the nursing staff of the in-patient and outpatient transplant care centers and to the members of the stem cell transplant coordinator staff.
PY - 2008/6
Y1 - 2008/6
N2 - We postulated that fludarabine (Flu) instead of cyclophosphamide (Cy) combined with i.v. busulfan (Bu) as preconditioning for allogeneic hematopoietic stem cell transplantation (HSCT) would improve safety and retain antileukemic efficacy. Sixty-seven patients received BuCy2, and subsequently, 148 patients received Bu-Flu. We used a Bayesian method to compare outcomes between these nonrandomized patients. The groups had comparable pretreatment characteristics, except that Bu-Flu patients were older (46 versus 39 years, P < .01), more often had unrelated donors (47.3% versus 20.9%, P < .0003), and had shorter median follow-up (39.7 versus 74.6 months). To account for improved supportive care and other unidentified factors that may affect outcome ("period" effects), 78 acute myelogenous leukemia (AML) patients receiving Melphalan-Flu (MF), treated in parallel during this time (1997-2004) were used to estimate the period effect. The MF patients' outcomes worsened during this period. Therefore, the period effect is unlikely to explain the greatly improved outcome with Bu-Flu. Patients transplanted with Bu-Flu in the first complete remission (CR1) had a 3-year overall survival and event-free-survival (EFS) of 78% and 74%, respectively, whereas CR1 patients younger than age 41 had a 3-year EFS of 83%. These results support replacing BuCy ± ATG with Bu-Flu ± rabbit-antithymocyte globulin (ATG), and warrant a prospective comparison between allogeneic HSCT and conventional induction/consolidation chemotherapy for AML in CR1.
AB - We postulated that fludarabine (Flu) instead of cyclophosphamide (Cy) combined with i.v. busulfan (Bu) as preconditioning for allogeneic hematopoietic stem cell transplantation (HSCT) would improve safety and retain antileukemic efficacy. Sixty-seven patients received BuCy2, and subsequently, 148 patients received Bu-Flu. We used a Bayesian method to compare outcomes between these nonrandomized patients. The groups had comparable pretreatment characteristics, except that Bu-Flu patients were older (46 versus 39 years, P < .01), more often had unrelated donors (47.3% versus 20.9%, P < .0003), and had shorter median follow-up (39.7 versus 74.6 months). To account for improved supportive care and other unidentified factors that may affect outcome ("period" effects), 78 acute myelogenous leukemia (AML) patients receiving Melphalan-Flu (MF), treated in parallel during this time (1997-2004) were used to estimate the period effect. The MF patients' outcomes worsened during this period. Therefore, the period effect is unlikely to explain the greatly improved outcome with Bu-Flu. Patients transplanted with Bu-Flu in the first complete remission (CR1) had a 3-year overall survival and event-free-survival (EFS) of 78% and 74%, respectively, whereas CR1 patients younger than age 41 had a 3-year EFS of 83%. These results support replacing BuCy ± ATG with Bu-Flu ± rabbit-antithymocyte globulin (ATG), and warrant a prospective comparison between allogeneic HSCT and conventional induction/consolidation chemotherapy for AML in CR1.
KW - AML
KW - Allogeneic stem cell transplantation
KW - Cyclophosphamide
KW - Fludarabine
KW - MDS
KW - i.v. Busulfan
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U2 - 10.1016/j.bbmt.2008.03.009
DO - 10.1016/j.bbmt.2008.03.009
M3 - Article
C2 - 18489993
AN - SCOPUS:43449126806
SN - 1083-8791
VL - 14
SP - 672
EP - 684
JO - Biology of Blood and Marrow Transplantation
JF - Biology of Blood and Marrow Transplantation
IS - 6
ER -