title: Busulfan and melphalan as conditioning regimen for allogeneic hematopoietic stem cell transplantation in acute myeloid leukemia in first complete remission.
abstract: BACKGROUND
  Allogeneic hematopoietic stem cell transplantation with HLA-identical donors has been established for the treatment of acute myeloid leukemia patients for over 30 years with a cure rate of 50% to 60%.
  
  
  OBJECTIVE
  To analyze the overall survival of patients and identify factors that influence the outcomes of this type of transplant in patients in 1st complete remission who received a busulfan and melphalan combination as conditioning regimen.
  
  
  METHODS
  Twenty-five consecutive patients with acute myeloid leukemia were enrolled between 2003 and 2008. The median age was 34 years old (Range: 16 - 57 years). All patients received cyclosporine and methotrexate for prophylaxis against graft-versus-host disease. Median neutrophil engraftment time was 16 days (Range: 7 - 22 days) and 17 days (Range: 7 - 46 days) for platelets. Sinusoidal obstructive syndrome was observed in three patients, seven had grade II acute graft-versus-host disease and one extensive chronic graft-versus-host disease.
  
  
  RESULTS
  The overall survival by the Kaplan-Meier method was 48% after 36 months with a plateau at 36 months after transplantation. Intensive consolidation with high-dose arabinoside resulted in an improved survival (p-value = 0.0001), as did grade II acute graft-versus-host disease (p-value = 0.0377) and mild chronic graft-versus-host disease (p-value < 0.0001). Thirteen patients died, five due to infection within 100 days of transplant, two due to hemorrhages, one to infection and graftversus-host disease and three relapses followed by renal failure (one) and infection (two). The cause of death could not be determined for two patients.
  
  
  CONCLUSIONS
  The busulfan and melphalan conditioning regimen is as good as other conditioning regimens providing an excellent survival rate.
authors.affiliation: Bone Marrow Transplant Service, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - USP, São Paulo, SP, Brazil.
authors.forename: Nadjanara Dorna
authors.initials: ND
authors.lastname: Bueno
authors.forename: Frederico Luiz
authors.initials: FL
authors.lastname: Dulley
authors.forename: Rosaura
authors.initials: R
authors.lastname: Saboya
authors.forename: José Ulysses
authors.initials: JU
authors.lastname: Amigo Filho
authors.forename: Fabio Luiz
authors.initials: FL
authors.lastname: Coracin
authors.forename: Dalton de Alencar Fischer
authors.initials: Dde A
authors.lastname: Chamone