Reduced-intensity stem cell transplantation for acute myeloid leukemia with fludarabine-based conditioning with intravenous busulfan versus melphalan View Full Text


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Article Info

DATE

2020-03-12

AUTHORS

Takuya Yamashita, Akiyoshi Takami, Naoyuki Uchida, Takahiro Fukuda, Tetsuya Eto, Souichi Shiratori, Shuichi Ota, Takashi Akasaka, Shigesaburo Miyakoshi, Tadakazu Kondo, Michihiro Hidaka, Junya Kanda, Yoshiko Atsuta, Shingo Yano

ABSTRACT

Reduced-intensity conditioning (RIC) has been facilitating allogeneic hematopoietic cell transplantation (allo-HCT) for patients originally considered ineligible for HCT with myeloablative conditioning. Fludarabine (Flu) with reduced doses of busulfan (Bu) (Flu + Bu) and Flu with reduced doses of melphalan (Mel) (Flu + Mel) are widely used RIC regimens for acute myeloid leukemia (AML). A nationwide retrospective study comparing clinical outcomes of adult patients with AML receiving first allo-HCT after RIC between 2001 and 2010 was performed. Cumulative incidences of relapse were not significantly different among the Flu + ivBu-based (FBiv), Flu + poBu-based (FBpo), and Flu + Mel-based (FM) groups (p = 0.29). Non-relapse mortality (NRM) was significantly lower in patients receiving FBiv compared with FBpo (p = 0.003) and FM (p < 0.001). On multivariate analysis, there was no significant difference in overall survival, but FM was associated with a significantly lower risk of relapse (hazard ratio (HR) = 0.65, 95% confidence interval (CI): 0.50–0.85, p = 0.002), higher NRM (HR = 1.60, 95% CI: 1.10–2.33, p = 0.013) and better leukemia-free survival (HR = 0.77, 95% CI: 0.63–0.95, p = 0.015) compared with FBiv. These results suggest that Flu + Mel has a more intense disease control potential and Flu + ivBu is less toxic than the other. Both RIC regimens provide similar survival outcomes and are effective and useful regimens for patients with AML who received allo-HCT. More... »

PAGES

1955-1965

References to SciGraph publications

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  • Journal

    TITLE

    Bone Marrow Transplantation

    ISSUE

    10

    VOLUME

    55

    Identifiers

    URI

    http://scigraph.springernature.com/pub.10.1038/s41409-020-0856-y

    DOI

    http://dx.doi.org/10.1038/s41409-020-0856-y

    DIMENSIONS

    https://app.dimensions.ai/details/publication/pub.1125556029

    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/32203256


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