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Comparison of fludarabine/melphalan (FluMel) with fludarabine/melphalan/BCNU or thiotepa (FBM/FTM) in patients with AML in first complete remission undergoing allogeneic hematopoietic stem cell transplantation - a registry study on behalf of the EBMT Acute Leukemia Working Party.
- Source :
-
Bone marrow transplantation [Bone Marrow Transplant] 2024 Feb; Vol. 59 (2), pp. 247-254. Date of Electronic Publication: 2023 Dec 02. - Publication Year :
- 2024
-
Abstract
- Conditioning protocols for patients undergoing allogeneic hematopoietic cell transplantation (allo-HCT) are being developed continuously to improve their anti-leukemic efficacy and reduce their toxicity. In this study, we compared the conditioning protocol of fludarabine with melphalan 140 mg/m <superscript>2</superscript> (FluMel) with conditioning protocols based on this same backbone but with an additional alkylating agent i.e., either fludarabine/BCNU (also known as carmustine)/melphalan (FBM), or fludarabine/thiotepa/melphalan (FTM) 110 mg/m <superscript>2</superscript> . We included 1272 adult patients (FluMel, n = 1002; FBM/FTM, n = 270) with acute myeloid leukemia (AML) with intermediate/poor cytogenetic risk in first complete remission (CR) from the registry of the EBMT Acute Leukemia Working Party. Despite patients in the FBM/FTM group were older (64.1 years vs. 59.8 years, p < 0.001) and had a worse Karnofsky performance score (KPS < 90, 33% vs. 24%, p = 0.003), they showed a better overall survival (OS) (2 y OS: 68.3% vs. 58.1%, p = 0.02) and less non-relapse mortality (NRM) (2 y NRM: 15.8% vs. 22.2%, p = 0.009) compared to patients treated with FluMel. No significant differences were observed in relapse incidence (RI) (2 y RI: 24.9% vs. 23.7%, p = 0.62). In conclusion, the addition of a second alkylating agent (BCNU/carmustine or thiotepa) to FluMel as FBM/FTM conditioning, improves OS in AML patients in first CR with intermediate/poor risk cytogenetics after allo-HCT.<br /> (© 2023. The Author(s).)
- Subjects :
- Humans
Adult
Melphalan pharmacology
Melphalan therapeutic use
Carmustine
Thiotepa pharmacology
Thiotepa therapeutic use
Busulfan
Antineoplastic Combined Chemotherapy Protocols adverse effects
Transplantation Conditioning methods
Transplantation, Homologous adverse effects
Recurrence
Pathologic Complete Response
Alkylating Agents
Retrospective Studies
Leukemia, Myeloid, Acute
Hematopoietic Stem Cell Transplantation methods
Graft vs Host Disease etiology
Vidarabine analogs & derivatives
Subjects
Details
- Language :
- English
- ISSN :
- 1476-5365
- Volume :
- 59
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- Bone marrow transplantation
- Publication Type :
- Academic Journal
- Accession number :
- 38040842
- Full Text :
- https://doi.org/10.1038/s41409-023-02150-w