title: Myeloablative reduced-toxicity i.v. busulfan-fludarabine and allogeneic hematopoietic stem cell transplant for patients with acute myeloid leukemia or myelodysplastic syndrome in the sixth through eighth decades of life.
abstract: The optimal pretransplant regimen for acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS) in patients ≥ 55 years of age remains to be determined. The myeloablative reduced-toxicity 4-day regimen i.v. busulfan (Bu) (130 mg/m(2)) and i.v. fludarabine (Flu) (40 mg/m(2)) is associated with low morbidity and mortality. We analyzed 79 patients ≥ 55 years of age (median, 58 years) with AML (n = 63) or MDS (n = 16) treated with i.v. Bu-Flu conditioning regimens between 2001 and 2009 (median follow-up, 24 months). The patients who received this regimen had a good performance status. The 2-year overall survival (OS) rates for patients in first complete remission (CR1), second CR (CR2), or refractory disease and for all patients at time of transplantation were 71%, 44%, 32%, and 46%, respectively; 2-year event-free survival (EFS) rates for patients in CR1, CR2, or refractory disease at time of transplantation and for all patients were 68%, 42%, 30%, and 44%, respectively. One-year transplant-related mortality (TRM) rates for patients who were in CR or who had active disease at the time of transplantation were 19% and 20%, respectively. Grade II-IV acute graft-versus-host (aGVHD) disease was diagnosed in 40% of the patients. Our results suggest that age alone should not be the primary reason for exclusion from receiving myeloablative reduced-toxicity conditioning with i.v. Bu-Flu preceding transplantation in patients with AML/MDS.
authors.affiliation: Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
authors.forename: Gheath
authors.initials: G
authors.lastname: Alatrash
authors.forename: Marcos
authors.initials: M
authors.lastname: de Lima
authors.forename: Nelson
authors.initials: N
authors.lastname: Hamerschlak
authors.forename: Matteo
authors.initials: M
authors.lastname: Pelosini
authors.forename: Xuemei
authors.initials: X
authors.lastname: Wang
authors.forename: Lianchun
authors.initials: L
authors.lastname: Xiao
authors.forename: Fabio
authors.initials: F
authors.lastname: Kerbauy
authors.forename: Alexandre
authors.initials: A
authors.lastname: Chiattone
authors.forename: Gabriela
authors.initials: G
authors.lastname: Rondon
authors.forename: Muzaffar H
authors.initials: MH
authors.lastname: Qazilbash
authors.forename: Sergio A
authors.initials: SA
authors.lastname: Giralt
authors.forename: Leandro
authors.initials: L
authors.lastname: de Padua Silva
authors.forename: Chitra
authors.initials: C
authors.lastname: Hosing
authors.forename: Partow
authors.initials: P
authors.lastname: Kebriaei
authors.forename: Weiqing
authors.initials: W
authors.lastname: Zhang
authors.forename: Yago
authors.initials: Y
authors.lastname: Nieto
authors.forename: Rima M
authors.initials: RM
authors.lastname: Saliba
authors.forename: Richard E
authors.initials: RE
authors.lastname: Champlin
authors.forename: Borje S
authors.initials: BS
authors.lastname: Andersson
mesh_terms: D000208:Acute Disease; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D002066:Busulfan / Q000008:administration & dosage; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000401:mortality / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000401:mortality / Q000628:therapy; D011446:Prospective Studies; D015996:Survival Rate; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous; D014740:Vidarabine / Q000008:administration & dosage / Q000031:analogs & derivatives
chemical_list: D014740:Vidarabine; D002066:Busulfan; C024352:fludarabine