title: Reduced-intensity conditioning with fludarabine and busulfan for allogeneic hematopoietic cell transplantation in elderly or infirm patients with advanced myeloid malignancies.
abstract: We report a retrospective single-center analysis of 112 consecutive patients that underwent allogeneic hematopoietic cell transplantation (HCT) after reduced-intensity conditioning (RIC) with fludarabine (FLU) and busulfan (BU) for the treatment of acute myeloid leukemia (AML), myelodysplastic syndrome (MDS) and myeloproliferative syndrome (MPS) from 2005 to 2014. Three-year event-free survival (EFS) and overall survival (OS) were 46 and 58 %, respectively. Patients ≥60 years of age showed a similar outcome compared to younger patients (3-year OS 55 vs. 61 %, p = 0.96; 3-year EFS 46 vs. 46 %, p = 0.82). Cumulative incidence of non-relapse mortality (NRM) at 3 years adjusted for relapse as competing risk was 25 % for patients aged <60 years and 15 % for older patients (p = 0.15). Infusions of higher CD34(+) blood stem cell doses were associated with a significantly better outcome in the elderly subgroup (3-year OS 82 vs. 39 %, p = 0.007). Moreover, complete donor chimerism at day +100 was associated with a significantly improved survival (3-year OS 69 vs. 23 %, p = 0.003). In conclusion, our data suggest that RIC with FLU/BU enables long-term disease-free survival even in an elderly patient population. Age has no negative impact on the outcome of allogeneic HCT, and decision for transplant should be based on disease risk and performance status rather than age alone.
authors.affiliation: Division of Blood and Marrow Transplantation, Department of Medicine, Stanford University, Stanford, CA, USA.|Department of Hematology and Oncology, University Hospital Tübingen, Otfried-Müller-Straße 10, 72076, Tübingen, Germany.
authors.forename: Dominik
authors.initials: D
authors.lastname: Schneidawind
authors.affiliation: Institute of Pathology and Neuropathology, Eberhard Karls Universität Tübingen, Tübingen, Germany.|Department of Hematology and Oncology, University Hospital Tübingen, Otfried-Müller-Straße 10, 72076, Tübingen, Germany.
authors.forename: Birgit
authors.initials: B
authors.lastname: Federmann
authors.affiliation: Department of Pathology, Stanford University, Stanford, CA, USA.|Department of Hematology and Oncology, University Hospital Tübingen, Otfried-Müller-Straße 10, 72076, Tübingen, Germany.
authors.forename: Corina
authors.initials: C
authors.lastname: Buechele
authors.affiliation: Department of Hematology and Oncology, University Hospital Tübingen, Otfried-Müller-Straße 10, 72076, Tübingen, Germany.
authors.forename: Andrea
authors.initials: A
authors.lastname: Helwig
authors.affiliation: Department of Hematology and Oncology, University Hospital Tübingen, Otfried-Müller-Straße 10, 72076, Tübingen, Germany.
authors.forename: Jörg
authors.initials: J
authors.lastname: Schmohl
authors.affiliation: Department of Hematology and Oncology, University Hospital Tübingen, Otfried-Müller-Straße 10, 72076, Tübingen, Germany.
authors.forename: Wichard
authors.initials: W
authors.lastname: Vogel
authors.affiliation: Department of Hematology and Oncology, University Hospital Tübingen, Otfried-Müller-Straße 10, 72076, Tübingen, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Faul
authors.affiliation: Department of Hematology and Oncology, University Hospital Tübingen, Otfried-Müller-Straße 10, 72076, Tübingen, Germany.
authors.forename: Lothar
authors.initials: L
authors.lastname: Kanz
authors.affiliation: Department of Hematology and Oncology, University Hospital Tübingen, Otfried-Müller-Straße 10, 72076, Tübingen, Germany. wolfgang.bethge@med.uni-tuebingen.de.
authors.forename: Wolfgang A
authors.initials: WA
authors.lastname: Bethge
mesh_terms: D000328:Adult; D000368:Aged; D001855:Bone Marrow Diseases / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D002066:Busulfan / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D019172:Transplantation Conditioning / Q000379:methods*; D014184:Transplantation, Homologous / Q000379:methods; D014740:Vidarabine / Q000008:administration & dosage / Q000031:analogs & derivatives*
chemical_list: D014740:Vidarabine; D002066:Busulfan; C024352:fludarabine
keywords: Aged patients; Allogeneic HCT; Busulfan; Fludarabine; Myeloid malignancies; RIC