BACKGROUND: Fludarabine plus busulfan (FB) and fludarabine plus melphalan (FM) are 2 widely used reduced-intensity conditioning (RIC) regimens for allogeneic hematopoietic stem cell transplantation (allo-SCT). METHODS: The current survey compared transplantation outcomes for a cohort of 394 acute myeloid leukemia (AML) patients given bone marrow or peripheral blood stem cells from human leukocyte antigen-identical siblings after FB (n = 218) or FM (n = 176). Patients given manipulated grafts and those given T-cell-depleting agents (anti-thymocyte globulins or alemtuzumab) were not included. RESULTS: At the time of transplantation, 266 patients (68%) were experiencing their first complete remission (CR), 69 (18%) were experiencing a later CR, and 59 (15%) had advanced disease. The incidences of acute and chronic graft-versus-host disease were similar in the 2 groups of patients. The 2-year relapse incidence (RI), nonrelapse mortality (NRM) rate, leukemia-free survival (LFS) rate, and overall survival (OS) rate were 31% ± 3%, 18% ± 3%, 51% ± 4%, and 54% ± 4%, respectively, for FB patients and 20% ± 3% (P = .007), 20% ± 3% (P = .4), 60% ± 4% (P = .08), and 62% ± 4% (P = .2), respectively, for FM patients. Among FB patients given intravenous busulfan (n = 81), the 2-year RI, NRM, LFS, and OS rates were 26% ± 5% (P = .43 vs FM patients), 25% ± 6% (P = .18), 49% ± 7% (P = .07), and 54% ± 7% (P = .13), respectively. In multivariate analyses, FM was associated with a lower RI (hazard ratio [HR], 0.5; P = .01) and a trend toward higher NRM (HR, 1.6; P = .1) with similar LFS (HR, 0.8; P = .2) and OS (HR, 0.9; P = .6). CONCLUSIONS: These results suggest that although FM provides better AML control than FB as an RIC regimen for allo-SCT, the 2 regimens provide similar survival. Multicenter randomized studies are needed to confirm these findings.
BACKGROUND:Fludarabine plus busulfan (FB) and fludarabine plus melphalan (FM) are 2 widely used reduced-intensity conditioning (RIC) regimens for allogeneic hematopoietic stem cell transplantation (allo-SCT). METHODS: The current survey compared transplantation outcomes for a cohort of 394 acute myeloid leukemia (AML) patients given bone marrow or peripheral blood stem cells from human leukocyte antigen-identical siblings after FB (n = 218) or FM (n = 176). Patients given manipulated grafts and those given T-cell-depleting agents (anti-thymocyte globulins or alemtuzumab) were not included. RESULTS: At the time of transplantation, 266 patients (68%) were experiencing their first complete remission (CR), 69 (18%) were experiencing a later CR, and 59 (15%) had advanced disease. The incidences of acute and chronic graft-versus-host disease were similar in the 2 groups of patients. The 2-year relapse incidence (RI), nonrelapse mortality (NRM) rate, leukemia-free survival (LFS) rate, and overall survival (OS) rate were 31% ± 3%, 18% ± 3%, 51% ± 4%, and 54% ± 4%, respectively, for FB patients and 20% ± 3% (P = .007), 20% ± 3% (P = .4), 60% ± 4% (P = .08), and 62% ± 4% (P = .2), respectively, for FM patients. Among FB patients given intravenous busulfan (n = 81), the 2-year RI, NRM, LFS, and OS rates were 26% ± 5% (P = .43 vs FM patients), 25% ± 6% (P = .18), 49% ± 7% (P = .07), and 54% ± 7% (P = .13), respectively. In multivariate analyses, FM was associated with a lower RI (hazard ratio [HR], 0.5; P = .01) and a trend toward higher NRM (HR, 1.6; P = .1) with similar LFS (HR, 0.8; P = .2) and OS (HR, 0.9; P = .6). CONCLUSIONS: These results suggest that although FM provides better AML control than FB as an RIC regimen for allo-SCT, the 2 regimens provide similar survival. Multicenter randomized studies are needed to confirm these findings.
Authors: Tania Jain; Katie L Kunze; M'hamed Temkit; Daniel K Partain; Mrinal S Patnaik; James L Slack; Nandita Khera; William J Hogan; Vivek Roy; Pierre Noel; Jose F Leis; Lisa Z Sproat; Veena Fauble; Ruben A Mesa; Jeanne Palmer Journal: Bone Marrow Transplant Date: 2018-05-24 Impact factor: 5.483
Authors: Nilanjan Ghosh; Sairah Ahmed; Kwang Woo Ahn; Manoj Khanal; Carlos Litovich; Mahmoud Aljurf; Vera Ulrike Bacher; Christopher Bredeson; Narendranath Epperla; Nosha Farhadfar; César O Freytes; Siddhartha Ganguly; Bradley Haverkos; David Inwards; Rammurti T Kamble; Hillard M Lazarus; Lazaros Lekakis; Hemant S Murthy; Taiga Nishihori; Praveen Ramakrishnan; David A Rizzieri; Jean A Yared; Mohamed A Kharfan-Dabaja; Anna Sureda; Mehdi Hamadani Journal: JAMA Oncol Date: 2020-07-01 Impact factor: 31.777
Authors: Elizabeth DiMaggio; Jun-Min Zhou; Ryan Caddell; Rebecca Tombleson; Janelle Perkins; Claudio Anasetti; Farhad Khimani; Joseph Pidala; Taiga Nishihori; Lia Perez; Brian Betts; Hugo F Fernandez; Asmita Mishra Journal: Leuk Lymphoma Date: 2020-03-05
Authors: Zheng Zhou; Rajneesh Nath; Jan Cerny; Hai-Lin Wang; Mei-Jie Zhang; Hisham Abdel-Azim; Vaibhav Agrawal; Gulrayz Ahmed; A Samer Al-Homsi; Mahmoud Aljurf; Hassan B Alkhateeb; Amer Assal; Ulrike Bacher; Ashish Bajel; Qaiser Bashir; Minocher Battiwalla; Vijaya Raj Bhatt; Michael Byrne; Jean-Yves Cahn; Mitchell Cairo; Hannah Choe; Edward Copelan; Corey Cutler; Moussab B Damlaj; Zachariah DeFilipp; Marcos De Lima; Miguel Angel Diaz; Nosha Farhadfar; James Foran; César O Freytes; Aaron T Gerds; Usama Gergis; Michael R Grunwald; Zartash Gul; Mehdi Hamadani; Shahrukh Hashmi; Mark Hertzberg; Gerhard C Hildebrandt; Nasheed Hossain; Yoshihiro Inamoto; Luis Isola; Tania Jain; Rammurti T Kamble; Muhammad Waqas Khan; Mohamed A Kharfan-Dabaja; Partow Kebriaei; Natasha Kekre; Nandita Khera; Hillard M Lazarus; Jane L Liesveld; Mark Litzow; Hongtao Liu; David I Marks; Rodrigo Martino; Vikram Mathews; Asmita Mishra; Hemant S Murthy; Arnon Nagler; Ryotaro Nakamura; Sunita Nathan; Taiga Nishihori; Rebecca Olin; Richard F Olsson; Neil Palmisiano; Sagar S Patel; Mrinal M Patnaik; Attaphol Pawarode; Miguel-Angel Perales; Ioannis Politikos; Uday Popat; David Rizzieri; Brenda M Sandmaier; Bipin N Savani; Sachiko Seo; Nirav N Shah; Geoffrey L Uy; David Valcárcel; Leo F Verdonck; Edmund K Waller; Youjin Wang; Daniel Weisdorf; Baldeep Wirk; Eric Wong; Jean A Yared; Wael Saber Journal: Blood Adv Date: 2020-07-14
Authors: Vishal Dhere; Scott Edelman; Edmund K Waller; Amelia Langston; Michael Graiser; Erin C Connolly; Jeffrey M Switchenko; Natia Esiashvili; Mohammad K Khan Journal: Leuk Lymphoma Date: 2017-08-07