title: A pilot study of busulfan and melphalan as preparatory regimen prior to allogeneic bone marrow transplantation in refractory or relapsed hematological malignancies.
abstract: In this pilot study; we assessed the immunosuppressive and the antileukemic potential of a combination of busulfan and melphalan prior to allogeneic BMT in 25 adult patients with refractory or relapsed hematological malignancies. Twelve patients were transplanted for acute myeloid leukemia (relapse: five patients; primary refractory: four patients; second remission: two patients), two patients for primary refractory acute lymphoblastic leukemia, nine patients for chronic myelogenous leukemia (accelerated phase: six patients; blastic phase: three patients) and two patients for primary refractory lymphoma. All received an unmanipulated marrow from HLA-identical siblings. All patients but one engrafted (median time to ANC > or = 0.5 x 10(9)/l = 17 days, to platelets > or = 50 x 10(9)/l = 29 days). Full chimerism was documented in the seven evaluable patients. The probability for developing acute GVHD was 58%. Complete remission was obtained in 17/18 measurable patients. With a 42 month median follow-up, eight patients are alive in unmaintained remission. The 4-year probabilities for relapse, survival, and DFS are respectively: 42%, 35%, and 31%. These results show that the combination of busulfan and melphalan ensures an effective immunosuppression allowing long-term engraftment. This regimen can provide long-term disease-free survival in patients with high-risk disease and thus represents an interesting alternative to the CY and/or TBI-containing regimens.
authors.affiliation: Institut Paoli-Calmettes, Marseille, France.
authors.forename: N
authors.initials: N
authors.lastname: Vey
authors.forename: B
authors.initials: B
authors.lastname: De Prijck
authors.forename: C
authors.initials: C
authors.lastname: Faucher
authors.forename: A M
authors.initials: AM
authors.lastname: Stoppa
authors.forename: D
authors.initials: D
authors.lastname: Sainty
authors.forename: M
authors.initials: M
authors.lastname: Lafage
authors.forename: R
authors.initials: R
authors.lastname: Bouabdallah
authors.forename: C
authors.initials: C
authors.lastname: Chabannon
authors.forename: J
authors.initials: J
authors.lastname: Camerlo
authors.forename: J A
authors.initials: JA
authors.lastname: Gastaut
authors.forename: D
authors.initials: D
authors.lastname: Maraninchi
authors.forename: D
authors.initials: D
authors.lastname: Blaise
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016026:Bone Marrow Transplantation; D002066:Busulfan / Q000008:administration & dosage; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology; D019337:Hematologic Neoplasms / Q000628:therapy*; D006801:Humans; D007165:Immunosuppression Therapy; D008297:Male; D008558:Melphalan / Q000008:administration & dosage; D008875:Middle Aged; D010865:Pilot Projects; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous
chemical_list: D002066:Busulfan; D008558:Melphalan