Comparative analysis of reduced toxicity conditioning regimens between fludarabine plus melphalan and fludarabine plus busulfex in adult patients with acute lymphoblastic leukemia.
Jaehyun AhnSung Soo ParkDaehun KwagGi June MinSung Soo ParkSilvia ParkSung-Eun LeeByung-Sik ChoKi-Seong EomYoo-Jin KimHee-Je KimChang-Ki MinSeok-Goo ChoSung-Eun LeePublished in: Bone marrow transplantation (2024)
Reduced-toxicity conditioning (RTC) regimens aim to mitigate regimen-related toxicity while maintaining anti-leukemic efficacy in allogeneic hematopoietic stem cell transplantation (allo-HSCT). We assessed outcomes of RTC regimens utilizing melphalan versus intravenous busulfan combined with fludarabine in adult acute lymphoblastic leukemia (ALL) patients. A retrospective analysis was conducted with 149 consecutive adult ALL patients (median age 51, range 18-60) in remission undergoing allo-HSCT. Patients received either fludarabine 150 mg/BSA plus 2 days of melphalan 70 mg/BSA (FM140, n = 76) from 2009 to 2015 or fludarabine plus 3 days of busulfan 3.2 mg/kg (FB9.6, n = 73) from 2016 to 2021. At 5 years post-HSCT, FM140 demonstrated superior disease-free survival (53.4% vs. 30.5%, p = 0.007) and lower cumulative relapse (27.4% vs. 46.8%, p = 0.026) than FB9.6. Five-year overall survival and non-relapse mortality did not significantly differ. FM140 exhibited a higher incidence of acute graft-versus-host disease (GVHD) grades II-IV (49.3% vs. 30.3%, p = 0.016), though rates of acute GVHD grades III-IV and chronic GVHD were similar. Multivariate analysis identified Philadelphia chromosome and minimal residual disease positive status, and FB9.6 conditioning as predictors of increased relapse and poorer disease-free survival. FM140 RTC regimen displayed significantly reduced relapse and superior disease-free survival compared to FB9.6 in ALL patients undergoing allo-HSCT, highlighting its current clinical utility.
Keyphrases
- free survival
- allogeneic hematopoietic stem cell transplantation
- acute lymphoblastic leukemia
- end stage renal disease
- newly diagnosed
- ejection fraction
- high dose
- chronic kidney disease
- acute myeloid leukemia
- peritoneal dialysis
- patients undergoing
- prognostic factors
- coronary artery disease
- cardiovascular disease
- low dose
- rheumatoid arthritis
- gene expression
- systemic lupus erythematosus
- adipose tissue
- weight loss
- patient reported outcomes
- dna methylation
- skeletal muscle
- young adults
- extracorporeal membrane oxygenation
- hepatitis b virus
- patient reported