Details

Autor(en) / Beteiligte

• Shibata, Sho
• Arai, Yasuyuki
• Kondo, Tadakazu
• Mizuno, Shohei
• Harada, Kaito
• Miyakoshi, Shigesaburo
• Uchida, Naoyuki
• Maruyama, Yumiko
• Eto, Tetsuya
• Katsuoka, Yuna
• Matsue, Kosei
• Nishiwaki, Kaichi
• Takada, Satoru
• Doki, Noriko
• Itoh, Mitsuru
• Nagafuji, Koji
• Kawakita, Toshiro
• Tanaka, Junji
• Fukuda, Takahiro
• Atsuta, Yoshiko
• Yanada, Masamitsu

Titel

Advantages of Higher Busulfan Dose Intensity in Fludarabine-Combined Conditioning for Patients with Acute Myeloid Leukemia Undergoing Cord Blood Transplantation

Ist Teil von

• Transplantation and cellular therapy, 2023-05, Vol.29 (5), p.332.e1-332.e11

Ort / Verlag

United States: Elsevier Inc

Erscheinungsjahr

2023

Link zum Volltext

Quelle

MEDLINE

Beschreibungen/Notizen

• •Higher doses of the FLU/BU4 regimen compared to the FLU/BU2 regimen prolonged disease-free survival after in cord blood transplantation for acute myeloid leukemia.•FLU/BU4 was associated with a reduced rate of relapse without an increase in nonrelapse mortality.•FLU/BU4 is recommended over FLU/BU2 for patients without a complete response and younger patients.•FLU/BU4 is well tolerated in older patients. The alkylating agent busulfan is commonly used as conditioning in allogeneic hematopoietic stem cell transplantation for acute myeloid leukemia (AML). However, a consensus has not yet been reached regarding the optimal busulfan dose in cord blood transplantation (CBT). Therefore, we conducted this large nationwide cohort study to retrospectively analyze the outcomes of CBT in patients with AML receiving busulfan at intermediate (6.4 mg/kg i.v.; BU2) or higher (12.8 mg/kg i.v.; BU4) doses within a fludarabine/i.v. busulfan (FLU/BU) regimen. Among 475 patients who underwent their first CBT following FLU/BU conditioning between 2007 and 2018, 162 received BU2 and 313 received BU4. Multivariate analysis identified BU4 as a significant factor for longer disease-free survival (hazard ratio [HR], .85; 95% confidence interval [CI], .75 to .97; P = .014) and a lower relapse rate (HR, .84; 95% CI, .72 to .98; P = .030). No significant differences were observed in non-relapse mortality between BU4 and BU2 (HR, 1.05; 95% CI, .88-1.26; P = .57). Subgroup analyses showed that BU4 provided significant benefits for patients who underwent transplantation while not in complete remission (CR) and those age <60 years. Our present results suggest that higher busulfan doses are preferable in patients undergoing CBT, particularly those not in CR and younger patients.