title: Comparative analysis of BU and CY versus CY and TBI in full intensity unrelated marrow donor transplantation for AML, CML and myelodysplasia.
abstract: 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.
authors.affiliation: Wayne State University Karmanos Cancer Center, Detroit, MI, USA. ubertij@karmanos.org
authors.forename: J P
authors.initials: JP
authors.lastname: Uberti
authors.forename: M-A
authors.initials: MA
authors.lastname: Agovi
authors.forename: S
authors.initials: S
authors.lastname: Tarima
authors.forename: M
authors.initials: M
authors.lastname: Haagenson
authors.forename: S
authors.initials: S
authors.lastname: Gandham
authors.forename: C
authors.initials: C
authors.lastname: Anasetti
authors.forename: K S
authors.initials: KS
authors.lastname: Baker
authors.forename: B J
authors.initials: BJ
authors.lastname: Bolwell
authors.forename: M
authors.initials: M
authors.lastname: Bornhauser
authors.forename: K W
authors.initials: KW
authors.lastname: Chan
authors.forename: E
authors.initials: E
authors.lastname: Copelan
authors.forename: S M
authors.initials: SM
authors.lastname: Davies
authors.forename: J
authors.initials: J
authors.lastname: Finke
authors.forename: G A
authors.initials: GA
authors.lastname: Hale
authors.forename: C
authors.initials: C
authors.lastname: Kollman
authors.forename: P L
authors.initials: PL
authors.lastname: McCarthy
authors.forename: V
authors.initials: V
authors.lastname: Ratanatharathorn
authors.forename: O
authors.initials: O
authors.lastname: Ringdén
authors.forename: D J
authors.initials: DJ
authors.lastname: Weisdorf
authors.forename: J D
authors.initials: JD
authors.lastname: Rizzo
mesh_terms: 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
chemical_list: D019653:Myeloablative Agonists; D003520:Cyclophosphamide; D002066:Busulfan
references.citation: Bone Marrow Transplant. 1996 May;17(5):685-9
references.pmid: 8733682
references.citation: Biol Blood Marrow Transplant. 2006 Aug;12(8):876-84
references.pmid: 16864058
references.citation: Bone Marrow Transplant. 1995 Jun;15(6):825-8
references.pmid: 7581076
references.citation: Bone Marrow Transplant. 1991 Sep;8(3):211-5
references.pmid: 1958901
references.citation: Ann Intern Med. 1958 Nov;49(5):987-1003
references.pmid: 13595469
references.citation: Ann Intern Med. 1993 Feb 15;118(4):255-67
references.pmid: 8420443
references.citation: Blood. 1993 Apr 15;81(8):2187-93
references.pmid: 8471778
references.citation: Blood. 1995 Apr 15;85(8):2263-8
references.pmid: 7718899
references.citation: Biol Blood Marrow Transplant. 2008 Jul;14(7):748-58
references.pmid: 18541193
references.citation: Blood. 1994 May 1;83(9):2723-30
references.pmid: 8167351
references.citation: Blood. 1999 Apr 1;93(7):2196-201
references.pmid: 10090927
references.citation: Blood. 1999 Dec 1;94(11):3960-2
references.pmid: 10627126
references.citation: Bone Marrow Transplant. 1997 Jun;19(12):1169-73
references.pmid: 9208109
references.citation: Blood. 1992 May 15;79(10):2578-82
references.pmid: 1586710
references.citation: Bone Marrow Transplant. 1996 Apr;17(4):479-83
references.pmid: 8722342
references.citation: Semin Oncol. 1993 Aug;20(4 Suppl 4):33-8; quiz 39
references.pmid: 8342074
references.citation: Blood. 2002 Aug 15;100(4):1201-7
references.pmid: 12149198
references.citation: Biol Blood Marrow Transplant. 2002;8(9):493-500
references.pmid: 12374454
references.citation: Blood. 1997 Oct 15;90(8):3204-13
references.pmid: 9376604
references.citation: Stat Med. 1999 Mar 30;18(6):695-706
references.pmid: 10204198
references.citation: Br J Haematol. 2001 Sep;114(4):944-50
references.pmid: 11564090
references.citation: Blood. 2000 Sep 15;96(6):2062-8
references.pmid: 10979948
references.citation: Bone Marrow Transplant. 1995 Jul;16(1):31-42
references.pmid: 7581127
references.citation: Blood. 1999 Jun 15;93(12):4436-40
references.pmid: 10361142
references.citation: Blood. 2001 Dec 15;98(13):3569-74
references.pmid: 11739158
references.citation: Br J Haematol. 2002 Dec;119(4):1115-24
references.pmid: 12472596
references.citation: Biol Blood Marrow Transplant. 1999;5(6):347-56
references.pmid: 10595812
references.citation: J Immunol. 2004 Aug 1;173(3):2050-9
references.pmid: 15265940
references.citation: Blood. 1987 Nov;70(5):1382-8
references.pmid: 3311203
references.citation: Ann N Y Acad Sci. 1995 Dec 29;770:1-7
references.pmid: 8597352
references.citation: Bone Marrow Transplant. 1998 Sep;22(5):439-43
references.pmid: 9733266
references.citation: Blood. 1994 Sep 15;84(6):2036-43
references.pmid: 8081005
references.citation: Semin Oncol. 1993 Aug;20(4 Suppl 4):18-25; quiz 26
references.pmid: 8342071
references.citation: N Engl J Med. 1983 Dec 1;309(22):1347-53
references.pmid: 6355849
references.citation: N Engl J Med. 1993 Mar 4;328(9):593-602
references.pmid: 8429851
references.citation: Blood. 2002 Sep 15;100(6):1977-83
references.pmid: 12200355