Fludarabine Melphalan reduced-intensity conditioning allotransplanation provides similar disease control in lymphoid and myeloid malignancies: analysis of 344 patients.
This was an Australasian Bone Marrow Transplant Recipient Registry (ABMTRR)-based retrospective study assessing the outcome of Fludarabine Melphalan (FluMel) reduced-intensity conditioning between 1998 and 2008. Median follow-up was 3.4 years. There were 344 patients with a median age of 54 years (18-68). In all, 234 patients had myeloid malignancies, with AML (n=166) being the commonest indication. There were 110 lymphoid patients with non-hodgkins lymphoma (NHL) (n=64) the main indication. TRM at day 100 was 14% with no significant difference between the groups. OS and disease-free survival (DFS) were similar between myeloid and lymphoid patients (57 and 50% at 3 years, respectively). There was no difference in cumulative incidence of relapse or GVHD between groups. Multivariate analysis revealed four significant adverse risk factors for DFS: donor other than HLA-identical sibling donor, not in remission at transplant, previous autologous transplant and recipient CMV positive. Chronic GVHD was associated with improved DFS in multivariate analysis predominantly due to a marked reduction in relapse (HR:0.44, P=0.003). This study confirms that FluMel provides durable and equivalent remissions in both myeloid and lymphoid malignancies. Disease stage and chronic GVHD remain important determinants of outcome for FluMel allografting.
St Vincent's Hospital, Darlinghurst, New South Wales, Australia.
A
A
Bryant
Australasian Bone Marrow Transplant Recipient Registry, New South Wales, Sydney, Australia.
I
I
Nivison-Smith
Royal Brisbane Hospital, Herston, Queensland, Australia.
E S
ES
Pillai
Royal Brisbane Hospital, Herston, Queensland, Australia.
G
G
Kennedy
Royal Melbourne Hospital, Parkville, Victoria, Australia.
A
A
Kalff
Royal Melbourne Hospital, Parkville, Victoria, Australia.
D
D
Ritchie
Westmead Hospital, Westmead, New South Wales, Australia.
B
B
George
Westmead Hospital, Westmead, New South Wales, Australia.
M
M
Hertzberg
The Alfred Hospital, Melbourne, Victoria, Australia.
S
S
Patil
The Alfred Hospital, Melbourne, Victoria, Australia.
A
A
Spencer
1] St Vincent's Hospital, Darlinghurst, New South Wales, Australia [2] Royal North Shore Hospital, New South Wales, Sydney, Australia.
K
K
Fay
Royal Perth Hospital, Perth, Western Australia, Australia.
P
P
Cannell
Auckland City Hospital, Auckland, New Zealand.
L
L
Berkahn
Auckland City Hospital, Auckland, New Zealand.
R
R
Doocey
Christchurch City Hospital, Christchurch, New Zealand.
R
R
Spearing
St Vincent's Hospital, Darlinghurst, New South Wales, Australia.
J
J
Moore
D000293:Adolescent; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage; D001315:Australia; D016026:Bone Marrow Transplantation; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007951:Leukemia, Myeloid / Q000628:therapy; D015470:Leukemia, Myeloid, Acute / Q000628:therapy*; D008223:Lymphoma / Q000628:therapy; D008228:Lymphoma, Non-Hodgkin / Q000628:therapy*; D008297:Male; D008558:Melphalan / Q000008:administration & dosage*; D008875:Middle Aged; D015999:Multivariate Analysis; D019653:Myeloablative Agonists / Q000008:administration & dosage; D009520:New Zealand; D012008:Recurrence; D012074:Remission Induction; D012189:Retrospective Studies; D012307:Risk Factors; D019172:Transplantation Conditioning / Q000379:methods*; D016896:Treatment Outcome; D014740:Vidarabine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D055815:Young Adult
D000970:Antineoplastic Agents; D019653:Myeloablative Agonists; D014740:Vidarabine; C024352:fludarabine; D008558:Melphalan