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

Jesús Duque-Afonso*, Jürgen Finke, Maud Ngoya, Jacques Emmanuel Galimard, Charles Craddock, Kavita Raj, Adrian Bloor, Emma Nicholson, Matthias Eder, Orchard Kim, Thomas Valerius, John A. Snowden, Eleni Tholouli, Charles Crawley, Matthew Collin, Keith M.O. Wilson, Alain Gadisseur, Rachel Protheroe, Eva Maria Wagner-Drouet, Bipin N. SavaniAlexandros Spyridonidis, Fabio Ciceri, Arnon Nagler, Mohamad Mohty*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

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.

Original languageEnglish
Pages (from-to)247-254
Number of pages8
JournalBone Marrow Transplantation
Volume59
Issue number2
DOIs
StatePublished - Feb 2024
Externally publishedYes

Funding

FundersFunder number
EBMT

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