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

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.

• Authors: Edward A Copelan, Betty K Hamilton, Belinda Avalos, Kwang Woo Ahn, Brian J Bolwell, Xiaochun Zhu, Mahmoud Aljurf, Koen van Besien, Christopher Bredeson, Jean-Yves Cahn, Luciano J Costa, Marcos de Lima, Robert Peter Gale, Gregory A Hale, Joerg Halter, Mehdi Hamadani, Yoshihiro Inamoto, Rammurti T Kamble, Mark R Litzow, Alison W Loren, David 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 Wirk, Mary M Horowitz, Mukta Arora, Jeff Szer, Jorge Cortes, Matt E Kalaycio, Richard T Maziarz, Wael Saber
• Journal: Blood (Blood) Vol. 122 Issue 24 Pg. 3863-70 (Dec 05 2013) ISSN: 1528-0020 [Electronic] United States
• PMID: 24065243 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, Non-P.H.S., Research Support, U.S. Gov't, P.H.S.)

Chemical References

• Cyclophosphamide
• Busulfan

Topics

• Acute Disease
• Adolescent
• Adult
• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• Busulfan (administration & dosage)
• Child
• Child, Preschool
• Combined Modality Therapy
• Cyclophosphamide (administration & dosage)
• Disease-Free Survival
• Female
• Hematopoietic Stem Cell Transplantation (methods)
• Humans
• Leukemia, Myeloid (therapy)
• Male
• Middle Aged
• Multivariate Analysis
• Remission Induction
• Siblings
• Time Factors
• Transplantation, Homologous
• Treatment Outcome
• Unrelated Donors
• Whole-Body Irradiation
• Young Adult