TY - JOUR
T1 - Comparison of fludarabine/melphalan (FluMel) with fludarabine/melphalan/BCNU or thiotepa (FBM/FTM) in patients with AML in first complete remission undergoing allogeneic hematopoietic stem cell transplantation – a registry study on behalf of the EBMT Acute Leukemia Working Party
AU - Duque-Afonso, Jesús
AU - Finke, Jürgen
AU - Ngoya, Maud
AU - Galimard, Jacques Emmanuel
AU - Craddock, Charles
AU - Raj, Kavita
AU - Bloor, Adrian
AU - Nicholson, Emma
AU - Eder, Matthias
AU - Kim, Orchard
AU - Valerius, Thomas
AU - Snowden, John A.
AU - Tholouli, Eleni
AU - Crawley, Charles
AU - Collin, Matthew
AU - Wilson, Keith M.O.
AU - Gadisseur, Alain
AU - Protheroe, Rachel
AU - Wagner-Drouet, Eva Maria
AU - Savani, Bipin N.
AU - Spyridonidis, Alexandros
AU - Ciceri, Fabio
AU - Nagler, Arnon
AU - Mohty, Mohamad
N1 - Publisher Copyright:
© The Author(s) 2023.
PY - 2024/2
Y1 - 2024/2
N2 - Conditioning protocols for patients undergoing allogeneic hematopoietic cell transplantation (allo-HCT) are being developed continuously to improve their anti-leukemic efficacy and reduce their toxicity. In this study, we compared the conditioning protocol of fludarabine with melphalan 140 mg/m2 (FluMel) with conditioning protocols based on this same backbone but with an additional alkylating agent i.e., either fludarabine/BCNU (also known as carmustine)/melphalan (FBM), or fludarabine/thiotepa/melphalan (FTM) 110 mg/m2. We included 1272 adult patients (FluMel, n = 1002; FBM/FTM, n = 270) with acute myeloid leukemia (AML) with intermediate/poor cytogenetic risk in first complete remission (CR) from the registry of the EBMT Acute Leukemia Working Party. Despite patients in the FBM/FTM group were older (64.1 years vs. 59.8 years, p < 0.001) and had a worse Karnofsky performance score (KPS < 90, 33% vs. 24%, p = 0.003), they showed a better overall survival (OS) (2 y OS: 68.3% vs. 58.1%, p = 0.02) and less non-relapse mortality (NRM) (2 y NRM: 15.8% vs. 22.2%, p = 0.009) compared to patients treated with FluMel. No significant differences were observed in relapse incidence (RI) (2 y RI: 24.9% vs. 23.7%, p = 0.62). In conclusion, the addition of a second alkylating agent (BCNU/carmustine or thiotepa) to FluMel as FBM/FTM conditioning, improves OS in AML patients in first CR with intermediate/poor risk cytogenetics after allo-HCT.
AB - Conditioning protocols for patients undergoing allogeneic hematopoietic cell transplantation (allo-HCT) are being developed continuously to improve their anti-leukemic efficacy and reduce their toxicity. In this study, we compared the conditioning protocol of fludarabine with melphalan 140 mg/m2 (FluMel) with conditioning protocols based on this same backbone but with an additional alkylating agent i.e., either fludarabine/BCNU (also known as carmustine)/melphalan (FBM), or fludarabine/thiotepa/melphalan (FTM) 110 mg/m2. We included 1272 adult patients (FluMel, n = 1002; FBM/FTM, n = 270) with acute myeloid leukemia (AML) with intermediate/poor cytogenetic risk in first complete remission (CR) from the registry of the EBMT Acute Leukemia Working Party. Despite patients in the FBM/FTM group were older (64.1 years vs. 59.8 years, p < 0.001) and had a worse Karnofsky performance score (KPS < 90, 33% vs. 24%, p = 0.003), they showed a better overall survival (OS) (2 y OS: 68.3% vs. 58.1%, p = 0.02) and less non-relapse mortality (NRM) (2 y NRM: 15.8% vs. 22.2%, p = 0.009) compared to patients treated with FluMel. No significant differences were observed in relapse incidence (RI) (2 y RI: 24.9% vs. 23.7%, p = 0.62). In conclusion, the addition of a second alkylating agent (BCNU/carmustine or thiotepa) to FluMel as FBM/FTM conditioning, improves OS in AML patients in first CR with intermediate/poor risk cytogenetics after allo-HCT.
UR - http://www.scopus.com/inward/record.url?scp=85178425036&partnerID=8YFLogxK
U2 - 10.1038/s41409-023-02150-w
DO - 10.1038/s41409-023-02150-w
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C2 - 38040842
AN - SCOPUS:85178425036
SN - 0268-3369
VL - 59
SP - 247
EP - 254
JO - Bone Marrow Transplantation
JF - Bone Marrow Transplantation
IS - 2
ER -
