title: Allogeneic Hematopoietic Stem Cell Transplantation after Conditioning Regimens with Fludarabine/melphalan or Fludarabine/busulfan for Patients with Hematological Malignancies: A Single-center Analysis.
abstract: Objective Fludarabine plus melphalan (FM) and fludarabine plus busulfan (FB) are two major conditioning regimens for allogeneic hematopoietic stem cell transplantation (allo-HSCT). Methods We retrospectively analyzed patients who underwent allo-HSCT after a conditioning regimen consisting of FM or FB with/without total body irradiation for hematological malignancies between 2005 and 2014. Results There were 41 patients who met the criteria. The median follow-up time for the survivors was 3 years. Thirty-two patients received allo-HSCT after the FM regimen and nine patients received allo-HSCT after the FB regimen. Patients who received FB were older than those who received FM (p=0.041). There was no significant difference in the 3-year overall survival between patients who had received FB and those who had received FM (29.6% vs. 56.5%, p=0.267). The 3-year cumulative incidence of relapse was significantly higher in patients who had received FB than that in patients who had received FM (66.7% vs. 17.8%, p=0.004), and FB was an independent prognostic factor for relapse by a multivariate analysis (hazard ratio, 9.8; 95% confidential interval, 2.5-39.3; p=0.001). When we restricted the evaluation to patients with acute myeloid leukemia and myelodysplastic syndrome, the 3-year cumulative incidence of relapse was also significantly higher in patients who had received FB than that in patients who had received FM (75.0% vs. 16.1%, p=0.004). Conclusion The results suggest that FM may provide better disease control than FB.
authors.affiliation: Department of Hematology, Yokohama City University Medical Center, Japan.
authors.forename: Wataru
authors.initials: W
authors.lastname: Yamamoto
authors.forename: Taiki
authors.initials: T
authors.lastname: Andou
authors.forename: Megumi
authors.initials: M
authors.lastname: Itabashi
authors.forename: Satoshi
authors.initials: S
authors.lastname: Koyama
authors.forename: Yoshimi
authors.initials: Y
authors.lastname: Ishii
authors.forename: Ayumi
authors.initials: A
authors.lastname: Numata
authors.forename: Kenji
authors.initials: K
authors.lastname: Motohashi
authors.forename: Maki
authors.initials: M
authors.lastname: Hagihara
authors.forename: Kenji
authors.initials: K
authors.lastname: Matsumoto
authors.forename: Shin
authors.initials: S
authors.lastname: Fujisawa
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002066:Busulfan / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D019337:Hematologic Neoplasms / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods* / Q000401:mortality; D006801:Humans; D008297:Male; D008558:Melphalan / Q000627:therapeutic use; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D019172:Transplantation Conditioning / Q000379:methods*; D014184:Transplantation, Homologous / Q000009:adverse effects; D014740:Vidarabine / Q000031:analogs & derivatives / Q000627:therapeutic use
chemical_list: D000970:Antineoplastic Agents; D014740:Vidarabine; D002066:Busulfan; C024352:fludarabine; D008558:Melphalan