title: Outcomes following HSCT using fludarabine, busulfan, and thymoglobulin: a matched comparison to allogeneic transplants conditioned with busulfan and cyclophosphamide.
abstract: We have reported a lower incidence of acute graft-versus-host disease (aGVHD) with a novel conditioning regimen using low-dose rabbit antithymocyte globulin (ATG; Thymoglobulin [TG]) with fludarabine and intravenous busulfan (FluBuTG). To assess further this single-center experience, we performed a retrospective matched-pair analysis comparing outcomes of adult patients transplanted using the FluBuTG conditioning regimen with matched controls from patients reported to the CIBMTR receiving a first allogeneic hematopoietic stem cell transplant (HCT) after standard oral busulfan and cyclophosphamide (BuCy). One hundred twenty cases and 215 matched controls were available for comparison. Patients receiving FluBuTG had significantly less treatment related mortality (TRM; 12% versus 34%, P < .001) and grades II-IV aGVHD (15% versus 34%, P < .001) compared to BuCy patients. The risk of relapse was higher in the FluBuTG patients (42% versus 20%, P < .001). The risks of chronic GVHD (cGVHD) and disease free survival (DFS) were similar in the cases and controls. These results suggest that the novel regimen FluBuTG decreases the risk of aGVHD and TRM after HLA-identical sibling HSCT, but is associated with an increased risk of relapse, resulting in similar DFS. Whether these conditioning regimens may be more suitable for specific patient populations based on relapse risk requires testing in prospective randomized trials.
authors: Medical College of Wisconsin, Milwaukee, Wisconsin.
authors: Christopher N
authors: CN
authors: Bredeson
authors: Medical College of Wisconsin, Milwaukee, Wisconsin; Center for International Blood and Marrow Transplant Research, Milwaukee, Wisconsin.
authors: Mei-Jie
authors: MJ
authors: Zhang
authors: Medical College of Wisconsin, Milwaukee, Wisconsin; Center for International Blood and Marrow Transplant Research, Milwaukee, Wisconsin.
authors: Manza-A
authors: MA
authors: Agovi
authors: San Martino Hospital, Genoa, Italy.
authors: Andrea
authors: A
authors: Bacigalupo
authors: Alberta Blood and Marrow Transplant Program, Calgary, AB, Canada.
authors: Nizar J
authors: NJ
authors: Bahlis
authors: Massachusetts General Hospital, Boston, Massacuhsetts.
authors: Karen
authors: K
authors: Ballen
authors: Alberta Blood and Marrow Transplant Program, Calgary, AB, Canada.
authors: Christopher
authors: C
authors: Brown
authors: Alberta Blood and Marrow Transplant Program, Calgary, AB, Canada.
authors: M Ahsan
authors: MA
authors: Chaudhry
authors: Medical College of Wisconsin, Milwaukee, Wisconsin; Center for International Blood and Marrow Transplant Research, Milwaukee, Wisconsin.
authors: Mary M
authors: MM
authors: Horowitz
authors: City of Hope National Medical Center, Duarte, California.
authors: Seira
authors: S
authors: Kurian
authors: Alberta Blood and Marrow Transplant Program, Calgary, AB, Canada.
authors: Diana
authors: D
authors: Quinlan
authors: Eli Lilly and Company, Indianapolis, Indiana.
authors: Catherine E
authors: CE
authors: Muehlenbien
authors: Alberta Blood and Marrow Transplant Program, Calgary, AB, Canada.
authors: James A
authors: JA
authors: Russell
authors: Alberta Blood and Marrow Transplant Program, Calgary, AB, Canada.
authors: Lynn
authors: L
authors: Savoie
authors: Medical College of Wisconsin, Milwaukee, Wisconsin; Center for International Blood and Marrow Transplant Research, Milwaukee, Wisconsin. Electronic address: rizzo@mcw.edu.
authors: J Douglas
authors: JD
authors: Rizzo
authors: Alberta Blood and Marrow Transplant Program, Calgary, AB, Canada.
authors: Douglas A
authors: DA
authors: Stewart
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000008:administration & dosage; D000961:Antilymphocyte Serum; D002066:Busulfan / Q000008:administration & dosage; D002908:Chronic Disease; D003520:Cyclophosphamide / Q000008:administration & dosage; D018572:Disease-Free Survival; D005260:Female; D006086:Graft vs Host Disease / Q000401:mortality* / Q000517:prevention & control; D019337:Hematologic Neoplasms / Q000401:mortality / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019653:Myeloablative Agonists / Q000008:administration & dosage; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D019172:Transplantation Conditioning / Q000379:methods* / Q000401:mortality*; D014184:Transplantation, Homologous; D014740:Vidarabine / Q000008:administration & dosage / Q000031:analogs & derivatives
chemical_list: D000911:Antibodies, Monoclonal; D000961:Antilymphocyte Serum; D019653:Myeloablative Agonists; D003520:Cyclophosphamide; C512542:thymoglobulin; D014740:Vidarabine; D002066:Busulfan; C024352:fludarabine