Myeloablative busulfan/cytoxan conditioning versus reduced-intensity fludarabine/melphalan conditioning for allogeneic hematopoietic stem cell transplant in patients with acute myelogenous leukemia

• Type of Material: Article
• Authors: Vishal Dhere, Emory University; Scott Edelman, Emory University; Edmund K Waller, Emory University; Amelia A Langston, Emory University; Michael Graiser, Emory University; Erin C. Connolly, Emory University; Jeffrey M. Switchenko, Emory University; Natia Esiashvili, Emory University; Mohammad K. Khan, Emory University
• Language: English
• Date: 2018-01-01
• Publisher: Taylor & Francis: STM, Behavioural Science and Public Health Titles
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2017 Informa UK Limited, trading as Taylor & Francis Group
• Final Published Version (URL): http://dx.doi.org/10.1080/10428194.2017.1361027
• Title of Journal or Parent Work: Leukemia & Lymphoma
• ISSN: 1042-8194
• Volume: 59
• Issue: 4
• Start Page: 837
• End Page: 843
• Grant/Funding Information: Research reported in this publication was supported in part by the Biostatistics and Bioinformatics Shared Resource of Winship Cancer Institute of Emory University and NIH/NCI under award number P30CA138292.
• Keywords: Hematology; REGIMENS; Transplant toxicity; ACUTE MYELOID-LEUKEMIA; Oncology; MARROW TRANSPLANTATION; Life Sciences & Biomedicine; chemotherapeutic approaches; AML; Science & Technology; myeloid leukemias and dysplasias; CYCLOPHOSPHAMIDE
• Research Categories: Biology, Bioinformatics; Biology, Biostatistics; Health Sciences, Oncology

Abstract

Fludarabine and melphalan (Flu/Mel) has emerged as a more tolerable chemotherapy-based conditioning regimen compared with busulfan and cyclophosphamide (Bu/Cy) for allogeneic stem cell transplant (allo-hematopoietic stem cell transplantation (HSCT)) patients with acute myelogenous leukemia (AML). We conducted a retrospective review of a single-institution database including patients with AML who received allo-HSCT following conditioning with Mel/Flu or Bu/Cy-based regimens. We performed descriptive statistical analysis to examine patient demographics and clinical outcomes. We identified 156 patients meeting criteria between 2005 and 2014. Overall, patients conditioned with Bu/Cy were significantly younger, but more likely to be treated in an earlier era than those receiving Flu/Mel. Regimen choice was not associated with relapse rates (RR), relapse-free survival (RFS), or overall survival (OS) on both univariate and multivariable analyses. Bu/Cy was associated with increased non-relapse mortality (NRM) on multivariable analysis. These findings demonstrate that Flu/Mel provides non-inferior disease control and could be an appropriate regimen for selected patients.