Better leukemia-free and overall survival in AML in first remission following cyclophosphamide in combination with busulfan compared with TBI.
Cyclophosphamide combined with total body irradiation (Cy/TBI) or busulfan (BuCy) are the most widely used myeloablative conditioning regimens for allotransplants. Recent data regarding their comparative effectiveness are lacking. We analyzed data from the Center for International Blood and Marrow Transplant Research for 1230 subjects receiving a first hematopoietic cell transplant from a human leukocyte antigen-matched sibling or from an unrelated donor during the years 2000 to 2006 for acute myeloid leukemia (AML) in first complete remission (CR) after conditioning with Cy/TBI or oral or intravenous (IV) BuCy. Multivariate analysis showed significantly less nonrelapse mortality (relative risk [RR] = 0.58; 95% confidence interval [CI]: 0.39-0.86; P = .007), and relapse after, but not before, 1 year posttransplant (RR = 0.23; 95% CI: 0.08-0.65; P = .006), and better leukemia-free survival (RR = 0.70; 95% CI: 0.55-0.88; P = .003) and survival (RR = 0.68; 95% CI: 0.52-0.88; P = .003) in persons receiving IV, but not oral, Bu compared with TBI. In combination with Cy, IV Bu is associated with superior outcomes compared with TBI in patients with AML in first CR.
Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC;
Edward A
EA
Copelan
Betty K
BK
Hamilton
Belinda
B
Avalos
Kwang Woo
KW
Ahn
Brian J
BJ
Bolwell
Xiaochun
X
Zhu
Mahmoud
M
Aljurf
Koen
K
van Besien
Christopher
C
Bredeson
Jean-Yves
JY
Cahn
Luciano J
LJ
Costa
Marcos
M
de Lima
Robert Peter
RP
Gale
Gregory A
GA
Hale
Joerg
J
Halter
Mehdi
M
Hamadani
Yoshihiro
Y
Inamoto
Rammurti T
RT
Kamble
Mark R
MR
Litzow
Alison W
AW
Loren
David I
DI
Marks
Eduardo
E
Olavarria
Vivek
V
Roy
Mitchell
M
Sabloff
Bipin N
BN
Savani
Matthew
M
Seftel
Harry C
HC
Schouten
Celalettin
C
Ustun
Edmund K
EK
Waller
Daniel J
DJ
Weisdorf
Baldeep
B
Wirk
Mary M
MM
Horowitz
Mukta
M
Arora
Jeff
J
Szer
Jorge
J
Cortes
Matt E
ME
Kalaycio
Richard T
RT
Maziarz
Wael
W
Saber
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002066:Busulfan / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000008:administration & dosage; D018572:Disease-Free Survival; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D007951:Leukemia, Myeloid / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012074:Remission Induction; D035781:Siblings; D013997:Time Factors; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D061349:Unrelated Donors; D014916:Whole-Body Irradiation; D055815:Young Adult
D003520:Cyclophosphamide; D002066:Busulfan