| Literature DB >> 32663298 |
Zheng Zhou1, Rajneesh Nath2, Jan Cerny3, Hai-Lin Wang4, Mei-Jie Zhang4,5, Hisham Abdel-Azim6, Vaibhav Agrawal7, Gulrayz Ahmed8, A Samer Al-Homsi9, Mahmoud Aljurf10, Hassan B Alkhateeb11, Amer Assal12, Ulrike Bacher13, Ashish Bajel14, Qaiser Bashir15, Minocher Battiwalla16, Vijaya Raj Bhatt17, Michael Byrne18, Jean-Yves Cahn19, Mitchell Cairo20, Hannah Choe21, Edward Copelan22, Corey Cutler23, Moussab B Damlaj24, Zachariah DeFilipp25, Marcos De Lima26, Miguel Angel Diaz27, Nosha Farhadfar28, James Foran29, César O Freytes30, Aaron T Gerds31, Usama Gergis32, Michael R Grunwald22, Zartash Gul33, Mehdi Hamadani4, Shahrukh Hashmi34,35, Mark Hertzberg36, Gerhard C Hildebrandt37, Nasheed Hossain38, Yoshihiro Inamoto39, Luis Isola40, Tania Jain41, Rammurti T Kamble42, Muhammad Waqas Khan43, Mohamed A Kharfan-Dabaja44, Partow Kebriaei15, Natasha Kekre45, Nandita Khera46, Hillard M Lazarus47, Jane L Liesveld48, Mark Litzow49, Hongtao Liu50, David I Marks51, Rodrigo Martino52, Vikram Mathews53, Asmita Mishra54, Hemant S Murthy44, Arnon Nagler55,56, Ryotaro Nakamura57, Sunita Nathan58, Taiga Nishihori54, Rebecca Olin59, Richard F Olsson60,61, Neil Palmisiano62, Sagar S Patel63, Mrinal M Patnaik11, Attaphol Pawarode64, Miguel-Angel Perales65, Ioannis Politikos65, Uday Popat15, David Rizzieri66, Brenda M Sandmaier67, Bipin N Savani68, Sachiko Seo69, Nirav N Shah70, Geoffrey L Uy71, David Valcárcel72, Leo F Verdonck73, Edmund K Waller74, Youjin Wang75, Daniel Weisdorf76, Baldeep Wirk77, Eric Wong14, Jean A Yared78, Wael Saber4.
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.Entities:
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Year: 2020 PMID： 32663298 PMCID： PMC7362362 DOI： 10.1182/bloodadvances.2019001266
Source DB: PubMed Journal: Blood Adv ISSN： 2473-9529