title: Autologous stem cell transplantation for adult acute myelocytic leukemia in first remission-Better outcomes after busulfan and melphalan compared with busulfan and cyclophosphamide: A retrospective study from the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation (EBMT).
abstract: Autologous stem cell transplantation (ASCT) for adult acute myelogenous leukemia (AML) is a valid therapeutic option for patients with good-risk and intermediate-risk disease. The authors used the registry of the European Society for Blood and Marrow Transplantation to compare combined busulfan and melphalan (BUMEL) with combined busulfan and cyclophosphamide (BUCY) before transplantation.
  
  
  
  From 2005 to 2013, 853 patients with available cytogenetics underwent ASCT in first remission, including 257 after receiving BUMEL and 596 after receiving BUCY. The proportion of patients with good-risk AML was lower in those who received BUMEL (14% vs 20%; P = .02). More patients who received BUMEL underwent autograft in molecular remission (89% vs 78%; P = .02). Three years after transplantation, the relapse incidence (RI) was 48.7%, the leukemia-free survival (LFS) rate was 47.7%, the overall survival (OS) rate was 66.2%, and the nonrelapse mortality (NRM) rate was 3.6%.
  
  
  
  Patients who underwent an autograft after receiving BUMEL fared better than those who underwent an autograft after receiving BUCY with a lower RI (39.5% vs 52.2%; hazard ratio [HR], 0.65; 95% confidence interval [CI], 0.49-0.87; P = .003) a better LFS (55.4% vs 44.6%; HR, 0.69; 95% CI, 0.53-0.89; P = .005), and a better OS (73.8% vs 63%; HR, 0.62; 95% CI, 0.47-0.82; P = .0007). There was no difference in the NRM rate (BUMEL vs BUCY, 4.5% vs 3.2%, respectively). Among 74 patients in the BUMEL group and 187 in the BUCY group who underwent autograft in molecular remission, the RI was 30% versus 51%, respectively (univariate analysis; P = .01), and the LFS rate was 66% versus 47%, respectively (univariate analysis; P = .03).
  
  
  
  In patients with AML in first complete remission who undergo ASCT, the BUMEL combination is a better preparative regimen. Cancer 2017;123:824-31. © 2016 American Cancer Society.
authors.affiliation: Department of Hematology and Cellular Therapy, European Society for Blood and Marrow Transplantation (EBMT), National Institute of Health and Medical Research (INSERM) Unit 938, St. Antoine Public Assistance Hospital, Pierre and Marie Curie University, Paris, France.|EBMT Office, INSERM Unit 938, St. Antoine Public Assistance Hospital, Pierre and Marie Curie University, Paris, France.
authors.forename: Norbert-Claude
authors.initials: NC
authors.lastname: Gorin
authors.affiliation: EBMT Office, INSERM Unit 938, St. Antoine Public Assistance Hospital, Pierre and Marie Curie University, Paris, France.
authors.forename: Myriam
authors.initials: M
authors.lastname: Labopin
authors.affiliation: Department of Bone Marrow Transplantation and Oncohematology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, Poland.
authors.forename: Tomasz
authors.initials: T
authors.lastname: Czerw
authors.affiliation: Department of Oncology, University Hospital Bern, Bern, Switzerland.
authors.forename: Thomas
authors.initials: T
authors.lastname: Pabst
authors.affiliation: Aix Marseille University, CNRS, INSERM, CRCM, Institut Paoli-calmettes, Marseille, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Blaise
authors.affiliation: Department of Hematology, Haut-Leveque Hospital, University Hospital Center of Bordeaux, Pessac, France.
authors.forename: Pierre-Yves
authors.initials: PY
authors.lastname: Dumas
authors.affiliation: Department of Hematology, University Hospital Center Rebro, Zagreb, Croatia.
authors.forename: Damir
authors.initials: D
authors.lastname: Nemet
authors.affiliation: Stem Cell Transplant Unit, Rome Transplant Network, Tor Vergata University Polyclinic, Tor Vergata University, Rome, Italy.
authors.forename: William
authors.initials: W
authors.lastname: Arcese
authors.affiliation: Department of Cellular Biotechnology and Hematology, Louisiana Sapienza University, Rome, Italy.
authors.forename: Silvia Maria
authors.initials: SM
authors.lastname: Trisolini
authors.affiliation: Department of Hematology, First Affiliated Hospital of Soochow University, Suzhou Jiangsu, China.
authors.forename: Depei
authors.initials: D
authors.lastname: Wu
authors.affiliation: The Cancer University Institute of Toulouse Oncopole, Toulouse, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Huynh
authors.affiliation: Department of Hematology and Bone Marrow Transplantation, Rambam Medical Center, Haifa, Israel.|Technion-Israel Institute of Technology, Haifa, Israel.
authors.forename: Tsila
authors.initials: T
authors.lastname: Zuckerman
authors.affiliation: Department of Hematology, Free University Medical Center, Amsterdam, the Netherlands.
authors.forename: Ellen
authors.initials: E
authors.lastname: Meijer
authors.affiliation: Department of Hematology, Ege University Medical School, Izmir, Turkey.
authors.forename: Seckin
authors.initials: S
authors.lastname: Cagirgan
authors.affiliation: Daniel den Hoed Cancer Center, Erasmus Medical Center, Rotterdam, the Netherlands.
authors.forename: Jan
authors.initials: J
authors.lastname: Cornelissen
authors.affiliation: Department of Hematology and Cellular Therapy, European Society for Blood and Marrow Transplantation (EBMT), National Institute of Health and Medical Research (INSERM) Unit 938, St. Antoine Public Assistance Hospital, Pierre and Marie Curie University, Paris, France.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Houhou
authors.affiliation: Department of Hematology and Cellular Therapy, European Society for Blood and Marrow Transplantation (EBMT), National Institute of Health and Medical Research (INSERM) Unit 938, St. Antoine Public Assistance Hospital, Pierre and Marie Curie University, Paris, France.
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Polge
authors.affiliation: Department of Hematology and Cellular Therapy, European Society for Blood and Marrow Transplantation (EBMT), National Institute of Health and Medical Research (INSERM) Unit 938, St. Antoine Public Assistance Hospital, Pierre and Marie Curie University, Paris, France.
authors.forename: Mohamad
authors.initials: M
authors.lastname: Mohty
authors.affiliation: EBMT Office, INSERM Unit 938, St. Antoine Public Assistance Hospital, Pierre and Marie Curie University, Paris, France.|Department of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Arnon
authors.initials: A
authors.lastname: Nagler
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002066:Busulfan / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000627:therapeutic use; D005260:Female; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology; D008297:Male; D008558:Melphalan / Q000627:therapeutic use; D008875:Middle Aged; D012074:Remission Induction; D012189:Retrospective Studies; D033581:Stem Cell Transplantation; D019172:Transplantation Conditioning; D014182:Transplantation, Autologous
chemical_list: D003520:Cyclophosphamide; D002066:Busulfan; D008558:Melphalan
keywords: acute myelogenous leukemia; autologous stem cell transplantation; busulfan and melphalan; molecular remission; pretransplantation regimen