title: [Combination of busulfan with increased-dose of fludarabine as conditioning regimen for MDS and MDS-AML patients with allo-HSCT].
abstract: OBJECTIVE
  To investigate the safety and efficacy of allogeneic hematopoietic stem cell transplantation (allo-HSCT) for myelodysplastic syndrome (MDS) and secondary acute myelogenous leukemia (MDS-AML) using conditioning regimen with busulfan (Bu) and increased-dose of fludarabine (ID-Flu).
  
  
  METHODS
  A total of 49 patients with MDS or MDS-AML were treated by allo-HSCT, the clinical data was analyzed retrospectively.
  
  
  RESULTS
  All patients achieved hematopoietic reconstitution. Neutrophil engraftment was at 10 - 22 days (median 13 days), and platelet engraftment was at 8 - 66 days (median 16 days). The cumulative incidences of Ⅱ-Ⅳ degree acute graft-versus-host disease (GVHD), hemorrhagic cystitis (HC), and hepatic venous occlusive disease (VOD) were 28.6%, 14.3% and 2.0%, respectively. The transplant-related mortality (TRM) was only 4.1% at 100d and 8.2% at 1-92 months of followed-up (median 14 months) period. Overall survival (OS) and disease free survival (DFS) was 75.5%, 73.5%, respectively. Kaplan-Meier curve showed that 3-year OS and 3-year DFS was (71.1 ± 7.8)%, (66.7 ± 8.3)%, respectively, with a relapse incidence (RI) 16.3%. OS for MDS and MDS-AML was 81.5% and 68.2%, and RI in two settings was 3.7%, 31.8%, respectively. OS for MDS-AML at complete remission (CR) and non-CR subgroup was 83.3% and 50.0%, respectively, while cumulative RR was 16.7% and 50.0%, respectively. OS and RI except for non-CR subgroup were 82.1% and 7.7%. Univariate analysis showed that pre-HSCT disease status had correlation with OS (P=0.031), but age, decitabine in conditioning regimen, stem cell source, HLA matching, patient-donor gender, dose of mononuclear cells and GVHD had no correlation with OS.
  
  
  CONCLUSIONS
  Bu/ID-Flu conditioning regimen for MDS and MDS-AML has high efficiency, fewer complications, lower toxicity and TRM. The OS and DFS were higher and RI was lower except for refractory MDS-AML patients. The regimen is valuable for clinical application.
authors.affiliation: Department of Hematology, Peking University First Hospital, Beijing　100034, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Yuan
authors.affiliation: Department of Hematology, Peking University First Hospital, Beijing　100034, China.
authors.forename: Hanyun
authors.initials: H
authors.lastname: Ren
authors.affiliation: Department of Hematology, Peking University First Hospital, Beijing　100034, China.
authors.forename: Zhixiang
authors.initials: Z
authors.lastname: Qiu
authors.affiliation: Department of Hematology, Peking University First Hospital, Beijing　100034, China.
authors.forename: Yuan
authors.initials: Y
authors.lastname: Li
authors.affiliation: Department of Hematology, Peking University First Hospital, Beijing　100034, China.
authors.forename: Mangju
authors.initials: M
authors.lastname: Wang
authors.affiliation: Department of Hematology, Peking University First Hospital, Beijing　100034, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Liu
authors.affiliation: Department of Hematology, Peking University First Hospital, Beijing　100034, China.
authors.forename: Weilin
authors.initials: W
authors.lastname: Xu
authors.affiliation: Department of Hematology, Peking University First Hospital, Beijing　100034, China.
authors.forename: Yuhua
authors.initials: Y
authors.lastname: Sun
authors.affiliation: Department of Hematology, Peking University First Hospital, Beijing　100034, China.
authors.forename: Lihong
authors.initials: L
authors.lastname: Wang
authors.affiliation: Department of Hematology, Peking University First Hospital, Beijing　100034, China.
authors.forename: Zeyin
authors.initials: Z
authors.lastname: Liang
authors.affiliation: Department of Hematology, Peking University First Hospital, Beijing　100034, China.
authors.forename: Yujun
authors.initials: Y
authors.lastname: Dong
authors.affiliation: Department of Hematology, Peking University First Hospital, Beijing　100034, China.
authors.forename: Jinping
authors.initials: J
authors.lastname: Ou
authors.affiliation: Department of Hematology, Peking University First Hospital, Beijing　100034, China.
authors.forename: Wensheng
authors.initials: W
authors.lastname: Wang
authors.affiliation: Department of Hematology, Peking University First Hospital, Beijing　100034, China.
authors.forename: Yue
authors.initials: Y
authors.lastname: Yin
authors.affiliation: Department of Hematology, Peking University First Hospital, Beijing　100034, China.
authors.forename: Xinan
authors.initials: X
authors.lastname: Cen
authors.affiliation: Department of Hematology, Peking University First Hospital, Beijing　100034, China.
authors.forename: Qian
authors.initials: Q
authors.lastname: Wang
mesh_terms: D002066:Busulfan; D018572:Disease-Free Survival; D006086:Graft vs Host Disease; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D015470:Leukemia, Myeloid, Acute; D009190:Myelodysplastic Syndromes; D012008:Recurrence; D012074:Remission Induction; D012189:Retrospective Studies; D014019:Tissue Donors; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous; D014740:Vidarabine / Q000031:analogs & derivatives
chemical_list: D014740:Vidarabine; D002066:Busulfan; C024352:fludarabine