Outcomes following HSCT using fludarabine, busulfan, and thymoglobulin: a matched comparison to allogeneic transplants conditioned with busulfan and cyclophosphamide.
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.
Bredeson
Christopher N
CN
Medical College of Wisconsin, Milwaukee, Wisconsin.
Zhang
Mei-Jie
MJ
Medical College of Wisconsin, Milwaukee, Wisconsin; Center for International Blood and Marrow Transplant Research, Milwaukee, Wisconsin.
Agovi
Manza-A
MA
Medical College of Wisconsin, Milwaukee, Wisconsin; Center for International Blood and Marrow Transplant Research, Milwaukee, Wisconsin.
Bacigalupo
Andrea
A
San Martino Hospital, Genoa, Italy.
Bahlis
Nizar J
NJ
Alberta Blood and Marrow Transplant Program, Calgary, AB, Canada.
Ballen
Karen
K
Massachusetts General Hospital, Boston, Massacuhsetts.
Brown
Christopher
C
Alberta Blood and Marrow Transplant Program, Calgary, AB, Canada.
Chaudhry
M Ahsan
MA
Alberta Blood and Marrow Transplant Program, Calgary, AB, Canada.
Horowitz
Mary M
MM
Medical College of Wisconsin, Milwaukee, Wisconsin; Center for International Blood and Marrow Transplant Research, Milwaukee, Wisconsin.
Kurian
Seira
S
City of Hope National Medical Center, Duarte, California.
Quinlan
Diana
D
Alberta Blood and Marrow Transplant Program, Calgary, AB, Canada.
Muehlenbien
Catherine E
CE
Eli Lilly and Company, Indianapolis, Indiana.
Russell
James A
JA
Alberta Blood and Marrow Transplant Program, Calgary, AB, Canada.
Savoie
Lynn
L
Alberta Blood and Marrow Transplant Program, Calgary, AB, Canada.
Rizzo
J Douglas
JD
Medical College of Wisconsin, Milwaukee, Wisconsin; Center for International Blood and Marrow Transplant Research, Milwaukee, Wisconsin. Electronic address: rizzo@mcw.edu.
Stewart
Douglas A
DA
Alberta Blood and Marrow Transplant Program, Calgary, AB, Canada.
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
D000911:Antibodies, Monoclonal; D000961:Antilymphocyte Serum; D019653:Myeloablative Agonists; D003520:Cyclophosphamide; C512542:thymoglobulin; D014740:Vidarabine; D002066:Busulfan; C024352:fludarabine