title: Allogeneic hematopoietic stem-cell transplantation for acute myeloid leukemia in remission: comparison of intravenous busulfan plus cyclophosphamide (Cy) versus total-body irradiation plus Cy as conditioning regimen--a report from the acute leukemia working party of the European group for blood and marrow transplantation.
abstract: OBJECTIVE
  Cyclophosphamide (Cy) combined with total-body irradiation (TBI) or with busulfan (Bu) are currently the most common myeloablative regimens used in allogeneic stem-cell transplantation (alloSCT) in adults with acute myelogenous leukemia (AML). Intravenous (IV) Bu has more predictable bioavailability and a safer toxicity profile than the oral formulation. Comparative studies of outcomes have been performed between oral Bu/Cy and Cy/TBI, but there have been no comparative trials in the era of IV Bu.
  
  
  METHODS
  We performed a retrospective registry-based study comparing outcomes of patients with AML in first or second remission after alloSCT from sibling donors who underwent IV Bu/Cy (n = 795) or Cy/TBI (n = 864) conditioning.
  
  
  RESULTS
  Engraftment rate was 98% and 99% after IV Bu/Cy and Cy/TBI, respectively. Grade 2 to 4 acute graft-versus-host disease (GVHD) was significantly lower in the IV Bu/Cy compared with Cy/TBI group (P < .001). Similarly, chronic GVHD was significantly lower in the IV Bu/Cy compared with Cy/TBI group (P = .003). Cumulative incidence of 2-year nonrelapse mortality (NRM; ± standard deviation [SD]) was 12% ± 1% in the IV Bu/Cy group and 15% ± 2% in the Cy/TBI group (P = .14), and 2-year relapse incidence (RI; ± SD) was 26% ± 3% and 21% ± 1%, respectively (P = .012). Leukemia-free survival (LFS) rate (± SD) was 61% ± 2% after IV Bu/Cy and 64% ± 2% after Cy/TBI (P = .27). In multivariable analysis, adjusting for differences between both groups, patients who received IV Bu/Cy had lower acute and chronic GVHD, higher RI, and a trend toward lower NRM. LFS was not statistically different between the two conditioning regimens.
  
  
  CONCLUSIONS
  This retrospective study shows that final outcomes after myeloablative conditioning using IV Bu/Cy were not statistically different from those after Cy/TBI.
authors: Arnon Nagler and Avichai Shimoni, Chaim Sheba Medical Center, Tel Hasomer, Israel; Vanderson Rocha, Churchill Hospital, Oxford University Hospitals, Oxford, United Kingdom; Myriam Labopin and Mohamad Mohty, Hôpital Saint-Antoine, Paris University; Gerard Socie, Hôpital St Louis, Paris; Mauricette Michallet, Hôpital Edouard Herriot, Lyon; Ibrahim Yakoub-Agha, University Hospital Lille, France; Ali Unal, Erciyes Medical School, Kayseri, Turkey; Tarek Ben Othman, Centre National de Greffe de Moelle, Tunis, Tunisia; Antonio Campos, Instituto Portugues de Oncologia do Porto, Porto, Portugal; Liisa Volin, Helsinki University Central Hospital, Helsinki, Finland; Xavier Poire, Cliniques Universitaires St Luc, Brussels, Belgium; Mahmoud Aljurf, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia; Tamás Masszi, St Istvan and St Laszlo Hospital, Budapest, Hungary; Henrik Sengelov, National University Hospital, Copenhagen, Denmark; Jakob Passweg, University Hospital, Basel, Switzerland; and Hendrik Veelken, Leiden University Medical Center, Leiden, the Netherlands.
authors: Arnon
authors: A
authors: Nagler
authors: Vanderson
authors: V
authors: Rocha
authors: Myriam
authors: M
authors: Labopin
authors: Ali
authors: A
authors: Unal
authors: Tarek
authors: T
authors: Ben Othman
authors: Antonio
authors: A
authors: Campos
authors: Liisa
authors: L
authors: Volin
authors: Xavier
authors: X
authors: Poire
authors: Mahmoud
authors: M
authors: Aljurf
authors: Tamás
authors: T
authors: Masszi
authors: Gerard
authors: G
authors: Socie
authors: Henrik
authors: H
authors: Sengelov
authors: Mauricette
authors: M
authors: Michallet
authors: Jakob
authors: J
authors: Passweg
authors: Hendrik
authors: H
authors: Veelken
authors: Ibrahim
authors: I
authors: Yakoub-Agha
authors: Avichai
authors: A
authors: Shimoni
authors: Mohamad
authors: M
authors: Mohty
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002066:Busulfan / Q000008:administration & dosage; D059248:Chemoradiotherapy; D003520:Cyclophosphamide / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000401:mortality / Q000473:pathology / Q000517:prevention & control; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007275:Injections, Intravenous; D015470:Leukemia, Myeloid, Acute / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D009367:Neoplasm Staging; D011379:Prognosis; D012074:Remission Induction; D012189:Retrospective Studies; D015996:Survival Rate; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous; D014916:Whole-Body Irradiation; D055815:Young Adult
chemical_list: D003520:Cyclophosphamide; D002066:Busulfan