Comparative effectiveness of busulfan/cyclophosphamide versus busulfan/fludarabine myeloablative conditioning for allogeneic hematopoietic cell transplantation in acute myeloid leukemia and myelodysplastic syndrome

Sagar S Patel; Lisa Rybicki; Brad Pohlman; Brian Bolwell; Aaron T Gerds; Betty K Hamilton; Rabi Hanna; Matt Kalaycio; Navneet S Majhail; Ronald Sobecks

doi:10.1016/j.hemonc.2019.09.002

Comparative effectiveness of busulfan/cyclophosphamide versus busulfan/fludarabine myeloablative conditioning for allogeneic hematopoietic cell transplantation in acute myeloid leukemia and myelodysplastic syndrome

Hematol Oncol Stem Cell Ther. 2020 Sep;13(3):160-165. doi: 10.1016/j.hemonc.2019.09.002. Epub 2019 Oct 11.

Authors

Affiliations

¹ Blood and Marrow Transplant Program, Division of Hematology and Hematologic Malignancies, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.
² Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
³ Blood and Marrow Transplant Program, Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.
⁴ Pediatric Blood and Marrow Transplant Program, Pediatrics Institute and Children's Hospital, Cleveland Clinic, Cleveland, OH, USA.
⁵ Blood and Marrow Transplant Program, Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA. Electronic address: sobeckr@ccf.org.

PMID: 31628924
DOI: 10.1016/j.hemonc.2019.09.002

Abstract

Objective/background: Busulfan/cyclophosphamide (Bu/Cy) and busulfan/fludarabine (Bu/Flu) are both standard myeloablative conditioning (MAC) regimens for allogeneic hematopoietic cell transplantation (alloHCT). We compared the effectiveness of these regimens with a focus on quality of life (QOL).

Methods: This was a single center, retrospective analysis of adult acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) patients who underwent a first T-cell replete HLA-8/8 matched related or unrelated donor alloHCT. Patients received a myeloablative regimen of either parenteral Bu/Cy or Bu/Flu. Outcomes assessed included infections, graft-versus-host-disease (GVHD), relapse, relapse mortality (RM), relapse-free survival (RFS), nonrelapse mortality (NRM), overall survival (OS), and QOL.

Results: From 2008 to 2017, 126 AML and 84 MDS adult patients age ≥18 years were identified meeting inclusion criteria. In terms of QOL, there were no significant differences between Bu/Cy and Bu/Flu cohorts in the Functional Assessment of Cancer Therapy-Bone Marrow Transplant Scale (FACT-BMT) scores or mucositis severity for either AML or MDS patients. Amongst AML patients, those receiving Bu/Flu had more rapid neutrophil and platelet recovery and a shorter length of hospital stay (LOS); there were no differences in the other posttransplant outcomes. Similarly, amongst MDS patients, those receiving Bu/Flu had more rapid platelet recovery and a shorter LOS as well as more CMV infections, but less NRM and no differences in other outcomes.

Conclusion: We confirmed that myeloablative Bu/Flu conditioning has comparable clinical and QOL outcomes to Bu/Cy.

Keywords: Acute myeloid leukemia; Allogeneic hematopoietic cell transplantation; Conditioning regimens; Myeloablative; Myelodysplastic syndrome; Quality of life; Toxicity.

Publication types

Clinical Trial
Comparative Study

MeSH terms

Adult
Aged
Allografts
Busulfan / administration & dosage*
Cyclophosphamide / administration & dosage*
Disease-Free Survival
Female
Graft vs Host Disease / mortality
Graft vs Host Disease / prevention & control
Hematopoietic Stem Cell Transplantation*
Humans
Leukemia, Myeloid, Acute / mortality
Leukemia, Myeloid, Acute / therapy*
Male
Middle Aged
Myelodysplastic Syndromes / mortality
Myelodysplastic Syndromes / therapy*
Retrospective Studies
Survival Rate
Transplantation Conditioning*
Vidarabine / administration & dosage
Vidarabine / analogs & derivatives*

Substances

Cyclophosphamide
Vidarabine
Busulfan
fludarabine