Better leukemia-free and overall survival in AML in first remission following cyclophosphamide in combination with busulfan compared with TBI

Edward A. Copelan*, Betty K. Hamilton, Belinda R. Avalos, Kwang Woo Ahn, Brian J. Bolwell, Xiaochun Zhu, Mahmoud D. Aljurf, Koen W. van Besien, Christopher N. Bredeson, Jean-Yves Cahn, Luciano J. Costa, Marcos J. de Lima, Robert Peter Gale, Gregory A. Hale, Joerg Halter, Mehdi Hamadani, Yoshihiro Inamoto, Rammurti T. Kamble, Mark R. Litzow, Alison W. LorenDavid I. Marks, Eduardo Olavarria, Vivek Roy, Mitchell Sabloff, Bipin N. Savani, Matthew Seftel, Harry C. Schouten, Celalettin Ustun, Edmund K. Waller, Daniel J. Weisdorf, Baldeep M. Wirk, Mary M. Horowitz, Mukta Arora, Jeff Szer, Jorge Cortes, Matt E. Kalaycio, Richard T. Maziarz, Wael Saber

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

103 Citations (Web of Science)

Abstract

Cyclophosphamide combined with total body irradiation (Cy/TBI) or busulfan (BuCy) are the most widely used myeloablative conditioning regimens for allotransplants. Recent data regarding their comparative effectiveness are lacking. We analyzed data from the Center for International Blood and Marrow Transplant Research for 1230 subjects receiving a first hematopoietic cell transplant from a human leukocyte antigen-matched sibling or from an unrelated donor during the years 2000 to 2006 for acute myeloid leukemia (AML) in first complete remission (CR) after conditioning with Cy/TBI or oral or intravenous (IV) BuCy. Multivariate analysis showed significantly less nonrelapse mortality (relative risk [RR] = 0.58; 95% confidence interval [CI]: 0.39-0.86; P = .007), and relapse after, but not before, 1 year posttransplant (RR = 0.23; 95% CI: 0.08-0.65; P = .006), and better leukemia-free survival (RR = 0.70; 95% CI: 0.55-0.88; P = .003) and survival (RR = 0.68; 95% CI: 0.52-0.88; P = .003) in persons receiving IV, but not oral, Bu compared with TBI. In combination with Cy, IV Bu is associated with superior outcomes compared with TBI in patients with AML in first CR.
Original languageEnglish
Pages (from-to)3863-3870
JournalBlood
Volume122
Issue number24
DOIs
Publication statusPublished - 5 Dec 2013

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