Fludarabine/TBI 8 Gy versus fludarabine/treosulfan conditioning in patients with AML in first complete remission: a study from the Acute Leukemia Working Party of the EBMT.

Abstract

The optimal reduced intensity conditioning (RIC) regimen is a matter of debate. We retrospectively compared conditioning with fludarabine plus fractionated total body irradiation of 8 Gy (FluTBI) and fludarabine plus treosulfan 30, 36 or 42 g/m2 (FluTreo) in 754 patients with AML above the age of 40 years undergoing an allogeneic hematopoietic stem cell transplant (HSCT) in first complete remission (CR). After balancing patient characteristics by propensity score matching of 115 patients in each group, FluTBI was associated with a significantly lower probability of relapse compared to FluTreo (18.3% vs. 34.7%, p = 0.018) which was counteracted by a higher non-relapse mortality (NRM, 16.8% vs. 5.3%, p = 0.02). Thus, overall survival and graft-versus-host disease-free and relapse-free survival at 2 years were similar between groups (OS 66.9% vs. 67.8%, GRFS 50.3% vs. 45.6%). Univariate analysis by age group demonstrated a higher NRM exclusively in patients ≥55 years of age treated with FluTBI compared to FluTreo (27.6% vs. 5.8%, p = 0.02), while a similarly low NRM was observed in patients <55 years in both groups (6.0% vs. 4.7%, p = ns). We conclude that both conditioning regimens are effective and safe, but FluTBI may better be reserved for younger patients below the age of 55 years.

• Authors: Gesine Bug, Myriam Labopin, Riitta Niittyvuopio, Matthias Stelljes, Hans Christian Reinhardt, Inken Hilgendorf, Nicolaus Kröger, Ain Kaare, Wolfgang Bethge, Kerstin Schäfer-Eckart, Mareike Verbeek, Stephan Mielke, Kristina Carlson, Ali Bazarbachi, Alexandros Spyridonidis, Bipin N Savani, Arnon Nagler, Mohamad Mohty
• Journal: Bone marrow transplantation (Bone Marrow Transplant) Vol. 58 Issue 6 Pg. 710-716 (06 2023) ISSN: 1476-5365 [Electronic] England
• PMID: 37002412 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2023. The Author(s).

Chemical References

• treosulfan
• fludarabine
• Busulfan
• Vidarabine

Topics

• Humans
• Adult
• Middle Aged
• Retrospective Studies
• Whole-Body Irradiation
• Busulfan (pharmacology, therapeutic use)
• Leukemia, Myeloid, Acute (therapy)
• Acute Disease
• Vidarabine (pharmacology, therapeutic use)
• Recurrence
• Transplantation Conditioning
• Hematopoietic Stem Cell Transplantation
• Graft vs Host Disease