Comparative analysis of BU and CY versus CY and TBI in full intensity unrelated marrow donor transplantation for AML, CML and myelodysplasia.
We retrospectively compared clinical outcomes in 1593 T-replete unrelated donor (URD) marrow transplant recipients with AML, MDS and CML who received myeloablative conditioning regimens of either BU and CY (BuCy), standard-dose Cy/TBI (1000-1260 cGy) or high-dose Cy/TBI (1320-1500 cGy). Subjects were drawn from patients transplanted between 1991 and 1999 facilitated by the National Marrow Donor Program. Patients who received high-dose Cy/TBI regimens were slightly younger, more likely to receive a mismatched transplant and to have intermediate or advanced disease compared with patients in the BuCy or standard-dose TBI group. Neutrophil recovery was significantly higher in the standard-dose CY/TBI group compared with the high-dose Cy/TBI or BuCy group. Patients who received the high-dose Cy/TBI regimen had an increased risk of developing grades III-IV aGVHD when compared with the control group who received BuCy (P = 0.011). OS, disease-free survival (DFS), TRM and relapse were not significantly different between any of the regimens. We conclude that BuCy, standard-dose and high-dose Cy/TBI regimens have equivalent efficacy profiles for OS, DFS, TRM and relapse risk in patients undergoing T-replete URD marrow transplantation for AML, CML and MDS.
Uberti
J P
JP
Wayne State University Karmanos Cancer Center, Detroit, MI, USA. ubertij@karmanos.org
Agovi
M-A
MA
Tarima
S
S
Haagenson
M
M
Gandham
S
S
Anasetti
C
C
Baker
K S
KS
Bolwell
B J
BJ
Bornhauser
M
M
Chan
K W
KW
Copelan
E
E
Davies
S M
SM
Finke
J
J
Hale
G A
GA
Kollman
C
C
McCarthy
P L
PL
Ratanatharathorn
V
V
Ringdén
O
O
Weisdorf
D J
DJ
Rizzo
J D
JD
D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D016026:Bone Marrow Transplantation; D002066:Busulfan / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy / Q000009:adverse effects; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007223:Infant; D007951:Leukemia, Myeloid / Q000628:therapy*; D015470:Leukemia, Myeloid, Acute / Q000628:therapy; D015466:Leukemia, Myeloid, Chronic-Phase / Q000628:therapy; D008297:Male; D008875:Middle Aged; D019653:Myeloablative Agonists / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D009190:Myelodysplastic Syndromes / Q000628:therapy*; D012189:Retrospective Studies; D019172:Transplantation Conditioning / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome; D014916:Whole-Body Irradiation / Q000009:adverse effects; D055815:Young Adult
D019653:Myeloablative Agonists; D003520:Cyclophosphamide; D002066:Busulfan
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