title: A modified busulfan and cyclophosphamide preparative regimen for allogeneic transplantation in myeloid malignancies.
abstract: BACKGROUND
  Busulfan/cyclophosphamide (Bu/Cy) is commonly used as a standard conditioning regimen without total body irradiation for patients with hematological myeloid malignancies undergoing hematopoietic stem cell transplantation (HSCT).
  
  
  OBJECTIVE
  To develop a new myeloablative conditioning regimen incorporating fludarabine (Flu) and cytarabine (Ara-c).
  
  
  METHODS
  A tertiary blood disease hospital in Tianjin, China.
  
  
  METHODS
  A Bu/Cy preparative regimen was used, modified by Flu 90 mg/m(2) and Ara-c 6 g/m(2) in 57 unselected patients (median age 37 years) with hematological myeloid malignancies. The patients were to receive allogeneic hematopoietic stem cell transplantation (allo-HSCT). Thirteen patients had high-risk leukemia, fifty patients had HLA matched sibling donors while seven patients had HLA mismatched sibling donors. Cy was given 50 mg/kg/day for 2 days while Bu was given 3.2 mg/kg/day intravenously for 3 days.
  
  
  METHODS
  Post-transplant donor chimerism, relapse tendency and minimal residual disease.
  
  
  RESULTS
  Extramedullar toxicity was relatively limited; the incidence of treatment-related mortality (TRM) within 100 days was 3.5 %. The incidence of grade II-IV, grade III-IV acute graft versus host disease (GVHD) and chronic GVHD of the evaluable patients were 21.1, 8.8 and 36.4 %, respectively. With a median follow up of 59 (13-96.5) months, TRM and relapse rate (RR) at eight years were 24.1 ± 5.8 and 14.7 ± 4.8 %, respectively. Disease free survival at eight years was 67.9 ± 6.2 % for the entire group, 60.0 ± 8.9 % for patients with AML, 77.3 ± 8.9 % for patients with CML, 70.0 ± 6.5 and 42.9 ± 18.7 % or matched sibling and mismatched sibling HSCT respectively.
  
  
  CONCLUSIONS
  The new regimen was associated with a low relapse rate, low incidence and severity of graft versus host disease and satisfactory survival for patients with myeloid malignancies.
authors.affiliation: Center of Hematopoietic Stem Cell Transplantation, Blood Disease Hospital, Institute of Hematology, Peking Union College, Chinese Academy of Medical Sciences, Tianjin, China.
authors.forename: Xiaojin
authors.initials: X
authors.lastname: Cai
authors.forename: Jialing
authors.initials: J
authors.lastname: Wei
authors.forename: Yi
authors.initials: Y
authors.lastname: He
authors.forename: Dongling
authors.initials: D
authors.lastname: Yang
authors.forename: Erlie
authors.initials: E
authors.lastname: Jiang
authors.forename: Yong
authors.initials: Y
authors.lastname: Huang
authors.forename: Mingzhe
authors.initials: M
authors.lastname: Han
authors.forename: Sizhou
authors.initials: S
authors.lastname: Feng
mesh_terms: D000293:Adolescent; D000328:Adult; D002066:Busulfan / Q000008:administration & dosage*; D002648:Child; D003520:Cyclophosphamide / Q000008:administration & dosage*; D018572:Disease-Free Survival; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D015470:Leukemia, Myeloid, Acute / Q000175:diagnosis* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D019172:Transplantation Conditioning / Q000379:methods*; D014184:Transplantation, Homologous; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents; D003520:Cyclophosphamide; D002066:Busulfan