Busulfan plus fludarabine as a myeloablative conditioning regimen compared with busulfan plus cyclophosphamide for acute myeloid leukemia in first complete remission undergoing allogeneic hematopoietic stem cell transplantation: a prospective and multicenter study

Hui Liu, Xiao Zhai, Zhaoyang Song, Jing Sun, Yang Xiao, Danian Nie, Yu Zhang, Fen Huang, Hongsheng Zhou, Zhiping Fan, Sanfang Tu, Yonghua Li, Xutao Guo, Guopan Yu, Qifa Liu, Hui Liu, Xiao Zhai, Zhaoyang Song, Jing Sun, Yang Xiao, Danian Nie, Yu Zhang, Fen Huang, Hongsheng Zhou, Zhiping Fan, Sanfang Tu, Yonghua Li, Xutao Guo, Guopan Yu, Qifa Liu

Abstract

Objective: We conducted a prospective, randomized, open-label, multicenter study to compare busulfan plus fludarabine (BuFlu) with busulfan plus cyclophosphamide (BuCy) as the conditioning regimen in allogeneic hematopoietic stem cell transplantation (allo-HSCT) for acute myeloid leukemia (AML) in first complete remission (CR1).

Methods: Totally 108 AML-CR1 patients undergoing allo-HSCT were randomized into BuCy (busulfan 1.6 mg/kg, q12 hours, -7 ~ -4d; cyclophosphamide 60 mg/kg.d, -3 ~ -2d) or BuFlu (busulfan 1.6 mg/kg, q12 hours, -5 ~ -2d; fludarabine 30 mg/m2.d, -6 ~ -2d) group. Hematopoietic engraftment, regimen-related toxicity (RRT), graft-versus-host disease (GVHD), transplant related mortality (TRM), and overall survival were compared between the two groups.

Results: All patients achieved hematopoietic reconstitution except for two patients who died of RRT during conditioning. All patients obtained complete donor chimerism by day +30 post-transplantation. The incidence of total and III-IV RRT were 94.4% and 81.5% (P = 0.038), and 16.7% and 0.0% (P = 0.002), respectively, in BuCy and BuFlu group. With a median follow up of 609 (range, 3-2130) days after transplantation, the 5-year cumulative incidence of TRM were 18.8 ± 6.9% and 9.9 ± 6.3% (P = 0.104); the 5-year cumulative incidence of leukemia relapse were 16.5 ± 5.8% and 16.2 ± 5.3% (P = 0.943); the 5-year disease-free survival and overall survival were 67.4 ± 7.6% and 75.3 ± 7.2% (P = 0.315), and 72.3 ± 7.5% and 81.9 ± 7.0% (P = 0.177), respectively in BuCy and BuFlu group.

Conclusion: Compared with BuCy, BuFlu as a myeloablative condition regimen was associated with lower toxicities and comparable anti-leukemic activity in AML-CR1 patients undergoing allo-HSCT.

Figures

Figure 1
Figure 1
Cumulative incidence of relapse (A), transplant related mortality (TRM) (B), overall survival (OS) (C) and disease free survival (DFS) (D). The 5-year cumulative incidence of relapse were 16.5 ± 5.8% and 16.2 ± 5.3% in BuCy and BuFlu group (P = 0.943). The 5-year cumulative incidence of TRM were 18.8 ± 6.9% and 9.9 ± 6.3% in BuCy and BuFlu group (P = 0.104). The 5-year cumulative OS were 72.3 ± 7.5% and 81.9 ± 7.0%, respectively, in BuCy and BuFlu group (P = 0.177), and DFS were 67.4 ± 7.6% and 75.3 ± 7.2%, respectively, in BuCy and BuFlu group (P =0.315)

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