Comparison of intravenous with oral busulfan in allogeneic hematopoietic stem cell transplantation with myeloablative conditioning regimens for pediatric acute leukemia.
Recent reports revealed that intravenous (iv) busulfan (BU) may not only reduce early nonrelapse mortality (NRM) but also improve overall survival (OS) probability in adults. Therefore, we retrospectively compared outcomes for 460 children with acute leukemia who underwent hematopoietic stem cell transplantation with either iv-BU (n = 198) or oral busulfan (oral-BU) (n = 262) myeloablative conditioning. OS at 3 years was 53.4% ± 3.7% with iv-BU and 55.1% ± 3.1% with oral-BU; the difference was not statistically significant (P = .77). OS at 3 years in 241 acute lymphoblastic leukemia and 219 acute myeloid leukemia patients was 56.4% ± 5.5% with iv-BU and 54.6% ± 4.1 with oral-BU (P = .51) and 51.0% ± 5.0% with iv-BU and 55.8% ± 4.8% with oral-BU (P = .83), respectively. Cumulative incidence of relapse at 3 years with iv-BU was similar to that with oral-BU (39.0% ± 3.6% and 36.4% ± 3.1%, respectively; P = .67). Cumulative incidence of NRM at 3 years was 16.6% ± 2.7% with iv-BU and 18.3% ± 2.5% with oral-BU (P = .51). Furthermore, multivariate analysis showed no significant survival advantage with iv-BU. In conclusion, iv-BU failed to show a significant survival advantage in children with acute leukemia.
Department of Cell Therapy and Transplantation Medicine, The University of Tokyo, Tokyo, Japan; Department of Pediatrics, The University of Tokyo, Tokyo, Japan; Department of Hematology/Oncology, Saitama Children's Medical Center, Saitama, Japan. Electronic address: katom-tky@umin.ac.jp.
Motohiro
M
Kato
Yoshiyuki
Y
Takahashi
Daisuke
D
Tomizawa
Yasuhiro
Y
Okamoto
Jiro
J
Inagaki
Katsuyoshi
K
Koh
Atsushi
A
Ogawa
Keiko
K
Okada
Yuko
Y
Cho
Junko
J
Takita
Hiroaki
H
Goto
Hisashi
H
Sakamaki
Hiromasa
H
Yabe
Keisei
K
Kawa
Ritsuro
R
Suzuki
Kazuko
K
Kudo
Koji
K
Kato
D000208:Acute Disease; D061605:Administration, Intravenous; D000284:Administration, Oral; D000293:Adolescent; D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage; D002066:Busulfan / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007938:Leukemia / Q000188:drug therapy*; D008297:Male; D019653:Myeloablative Agonists / Q000008:administration & dosage*; D012189:Retrospective Studies; D016019:Survival Analysis; D019172:Transplantation Conditioning / Q000379:methods*
D018906:Antineoplastic Agents, Alkylating; D019653:Myeloablative Agonists; D002066:Busulfan
Acute leukemia; Busulfan; Children