TY - JOUR
T1 - Fludarabine/busulfan versus fludarabine/total-body-irradiation (2 Gy) as conditioning prior to allogeneic stem cell transplantation in patients (≥60 years) with acute myelogenous leukemia
T2 - a study of the acute leukemia working party of the EBMT
AU - Heinicke, Thomas
AU - Labopin, Myriam
AU - Polge, Emmanuelle
AU - Niederwieser, Dietger
AU - Platzbecker, Uwe
AU - Sengelov, Henrik
AU - Choi, Goda
AU - Cornelissen, Jan
AU - Blaise, Didier
AU - Kuball, Jürgen
AU - van Gorkom, Gwendolyn
AU - Schaap, Nicolaas
AU - Potter, Victoria
AU - Paul, Franciane
AU - Savani, Bipin N
AU - Nagler, Arnon
AU - Mohty, Mohamad
N1 - Publisher Copyright:
© 2019, The Author(s), under exclusive licence to Springer Nature Limited.
PY - 2020/4
Y1 - 2020/4
N2 - Nonmyeloablative (NMA) conditioning regimens facilitate allogeneic stem cell transplantation (alloSCT) in elderly patients and/or in those with comorbidities. The acute leukemia working party (ALWP) of the European Society for Blood and Marrow Transplantation (EBMT) compared the outcomes of patients ≥60 years with AML in first complete remission (CR1), that had received an alloSCT following NMA conditioning, i.e. either fludarabine/busulfan (FB2) or fludarabine/total-body-irradiation-2Gy (FluTBI2Gy). A total of 1088 patients were included (median age 65 years). Donors were matched siblings (MSD) and matched unrelated donors (MUD) in 47% and 53%, respectively. In vivo T-cell depletion (TCD) was applied to 79% and none (0%) of patients in the FB2 and FluTBI2Gy groups, respectively. In the MSD group we found a trend for less extensive cGVHD in patients receiving FB2 with in vivo TCD, HR: 0.49, p = 0.08, and in those without worse NRM, HR: 2.14, p = 0.04, and a trend for more total cGVHD, HR: 1.61, p = 0.09. Patients transplanted from MUDs had a significantly higher incidence of total cGVHD, extensive cGVHD and a worse GRFS with FluTBI2Gy in comparison to FB2, HR: 2.44; p < 0.0001; HR 4.59; p < 0.00001 and HR: 1.35; p = 0.03, respectively. No differences were observed with respect to LFS, OS, RI, NRM, and aGVHD.
AB - Nonmyeloablative (NMA) conditioning regimens facilitate allogeneic stem cell transplantation (alloSCT) in elderly patients and/or in those with comorbidities. The acute leukemia working party (ALWP) of the European Society for Blood and Marrow Transplantation (EBMT) compared the outcomes of patients ≥60 years with AML in first complete remission (CR1), that had received an alloSCT following NMA conditioning, i.e. either fludarabine/busulfan (FB2) or fludarabine/total-body-irradiation-2Gy (FluTBI2Gy). A total of 1088 patients were included (median age 65 years). Donors were matched siblings (MSD) and matched unrelated donors (MUD) in 47% and 53%, respectively. In vivo T-cell depletion (TCD) was applied to 79% and none (0%) of patients in the FB2 and FluTBI2Gy groups, respectively. In the MSD group we found a trend for less extensive cGVHD in patients receiving FB2 with in vivo TCD, HR: 0.49, p = 0.08, and in those without worse NRM, HR: 2.14, p = 0.04, and a trend for more total cGVHD, HR: 1.61, p = 0.09. Patients transplanted from MUDs had a significantly higher incidence of total cGVHD, extensive cGVHD and a worse GRFS with FluTBI2Gy in comparison to FB2, HR: 2.44; p < 0.0001; HR 4.59; p < 0.00001 and HR: 1.35; p = 0.03, respectively. No differences were observed with respect to LFS, OS, RI, NRM, and aGVHD.
KW - VERSUS-HOST-DISEASE
KW - ACUTE MYELOID-LEUKEMIA
KW - BONE-MARROW-TRANSPLANTATION
KW - ANTI-THYMOCYTE GLOBULIN
KW - UNRELATED DONORS
KW - ANTITHYMOCYTE GLOBULIN
KW - HEMATOLOGIC MALIGNANCIES
KW - MYELODYSPLASTIC SYNDROME
KW - COMPLETE REMISSION
KW - CLINICAL-TRIALS
U2 - 10.1038/s41409-019-0720-0
DO - 10.1038/s41409-019-0720-0
M3 - Article
C2 - 31645668
SN - 0268-3369
VL - 55
SP - 729
EP - 739
JO - Bone Marrow Transplantation
JF - Bone Marrow Transplantation
IS - 4
ER -