The optimal conditioning for patients with acute myeloid leukemia in first complete remission treated with allogeneic hematopoietic cell transplantation (allo-HCT) has not been defined so far. In this retrospective study, we compared two “reduced-toxicity” regimens: intravenous busulfan at a total dose of 9.6 mg/kg (3 days) + fludarabine (Bu3/Flu) and total body irradiation at a dose of 8 Gy + fludarabine (TBI8Gy/Flu). In the entire study cohort (n = 518), the probabilities of overall survival (OS), leukemia-free survival (LFS), relapse and non-relapse mortality (NRM) at 2 years for Bu3/Flu and TBI8Gy/Flu were 62% vs. 72.5% (p = 0.051), 59.5% vs. 65% (p = 0.15), 30% vs. 20% (p = 0.01), and 10% vs. 14% (p = 0.18), respectively. In multivariate model for patients <50 years old, TBI8Gy/Flu was associated with improved LFS (hazard ratio (HR) = 0.5, p = 0.04), OS (HR = 0.31, p = 0.004), and survival free from both graft-versus-host disease and relapse (HR = 0.55, p = 0.03), as well as tendency to reduced risk of relapse (HR = 0.53, p = 0.08). Among patients aged 50 years or older the use of TBI8Gy/Flu was associated with increased incidence of NRM (HR = 3.9, p = 0.0009), with no significant impact on other outcome measures. We conclude that the use of TBI8Gy/Flu as “reduced-toxicity” regimen may be advised in younger patients with AML referred for allo-HCT.

Total body irradiation + fludarabine compared to busulfan + fludarabine as “reduced-toxicity conditioning” for patients with acute myeloid leukemia treated with allogeneic hematopoietic cell transplantation in first complete remission: a study by the Acute Leukemia Working Party of the EBMT / Giebel, S.; Labopin, M.; Sobczyk-Kruszelnicka, M.; Stelljes, M.; Byrne, J. L.; Fegueux, N.; Beelen, D. W.; Rovira, M.; Spyridonidis, A.; Blaise, D.; Bornhauser, M.; Karadogan, I.; Savani, B. N.; Nagler, A.; Mohty, M.; Martin, S.; Chevallier, P.; Neubauer, A.; Damaj, G.; Koc, Y.; Ganser, A.; Collin, M.; Yakoub-Agha, I.; Ozdogu, H.; Araujo, M. C.; Itala-Remes, M.; Orchard, K.; Isaksson, C.; Bethge, W.; Martin, H.; Aljurf, M.; Faber, E.; Caballero, D.; Zak, P.; Leleu, X.; Bay, J. -O.; Rohrlich, P. -S.; Kroger, N.; Huynh, A.; Schafer-Eckart, K.; Milpied, N.; Lenhoff, S.; Ho, A.; Lopez, J. L. B.; Mordini, N.; Lioure, B.; Halaburda, K.; Olivieri, A.; Gedde-Dahl, T.; Protheroe, R.; Tischer, J.; Klammer, M.; Clausen, J.; Potter, V.; Ladetto, M.; Tilly, H.; Deconinck, E.; Brecht, A.; Muller, L. P.; Heinicke, T.; Carrete, J. P. T.; Bazarbachi, A.; Remenyi, P.; Rubio, M. T.; Fanin, R.; Perez-Simon, J. A.; Niels, M.; Diez-Martin, J. L.; Arat, M.; Hermine, O.; Socie, G.; Cornelissen, J. J.; Santarone, S.; Guyotat, D.; Bulabois, C. E.; Bernasconi, P.; Johansson, J. -E.; Vrhovac, R.; Greinix, H.; Lorenzo, J. L. L.; Apte, S.; Craddock, C.; Kobbe, G.; Zahrani, M. A.; Dreger, P.; Lange, A.; Tbakhi, A.; Meijer, E.; Llamas, C. V.; Santasusana, J. M. R.; Corradini, P.; Benedetti, F.; Rambaldi, A.; Gandemer, V.; Malfuson, J. -V.; Kaare, A.; Risitano, A.; Petrini, M.; Selleri, C.; Wu, D.. - In: BONE MARROW TRANSPLANTATION. - ISSN 0268-3369. - 56:2(2021), pp. 481-491. [10.1038/s41409-020-01050-7]

Total body irradiation + fludarabine compared to busulfan + fludarabine as “reduced-toxicity conditioning” for patients with acute myeloid leukemia treated with allogeneic hematopoietic cell transplantation in first complete remission: a study by the Acute Leukemia Working Party of the EBMT

Olivieri A.;
2021-01-01

Abstract

The optimal conditioning for patients with acute myeloid leukemia in first complete remission treated with allogeneic hematopoietic cell transplantation (allo-HCT) has not been defined so far. In this retrospective study, we compared two “reduced-toxicity” regimens: intravenous busulfan at a total dose of 9.6 mg/kg (3 days) + fludarabine (Bu3/Flu) and total body irradiation at a dose of 8 Gy + fludarabine (TBI8Gy/Flu). In the entire study cohort (n = 518), the probabilities of overall survival (OS), leukemia-free survival (LFS), relapse and non-relapse mortality (NRM) at 2 years for Bu3/Flu and TBI8Gy/Flu were 62% vs. 72.5% (p = 0.051), 59.5% vs. 65% (p = 0.15), 30% vs. 20% (p = 0.01), and 10% vs. 14% (p = 0.18), respectively. In multivariate model for patients <50 years old, TBI8Gy/Flu was associated with improved LFS (hazard ratio (HR) = 0.5, p = 0.04), OS (HR = 0.31, p = 0.004), and survival free from both graft-versus-host disease and relapse (HR = 0.55, p = 0.03), as well as tendency to reduced risk of relapse (HR = 0.53, p = 0.08). Among patients aged 50 years or older the use of TBI8Gy/Flu was associated with increased incidence of NRM (HR = 3.9, p = 0.0009), with no significant impact on other outcome measures. We conclude that the use of TBI8Gy/Flu as “reduced-toxicity” regimen may be advised in younger patients with AML referred for allo-HCT.
2021
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11566/294531
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