title: Comparative Effectiveness of Busulfan and Fludarabine versus Fludarabine and 400 cGy Total Body Irradiation Conditioning Regimens for Acute Myeloid Leukemia/Myelodysplastic Syndrome.
abstract: Allogeneic hematopoietic cell transplantation conditioning regimen intensity has varied for patients with acute myeloid leukemia and myelodysplastic syndrome. A comparative effectiveness analysis was performed to assess outcomes of busulfan and fludarabine (BuFlu) versus those of fludarabine and 400 cGy total body irradiation (FluTBI) conditioning. Thirty-three subjects received BuFlu and 38 received FluTBI. The BuFlu group received more red blood cell transfusions (P = .02) and had a longer time to platelet recovery (P = .004). There were no differences between the regimens regarding incidence of acute or chronic graft-versus-host disease (GVHD), quality of life, or 2-year outcome estimates for relapse (48; 95% confidence interval [CI], 30 to 64 and 50; 95% CI, 33 to 65), nonrelapse mortality (29; 95% CI, 14 to 45 and 29; 95% CI, 15 to 44), relapse-free survival (27; 95% CI, 13 to 43 and 29; 95% CI, 16 to 44), and overall survival (35; 95% CI, 19 to 51; and 37; 95% CI, 22 to 52), respectively. These comparable outcomes have implications for health care resource utilization. Future prospective investigation comparing these regimens with larger patient cohorts and additional strategies to prevent relapse and limit toxicities as well as cost-effectiveness analyses are warranted.
authors.affiliation: Internal Medicine, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Moaath
authors.initials: M
authors.lastname: Mustafa Ali
authors.affiliation: Blood and Marrow Transplant Program, Cleveland Clinic Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Donna M
authors.initials: DM
authors.lastname: Abounader
authors.affiliation: Quantitative Health Sciences, Cleveland Clinic Lerner Research Institute, Cleveland, Ohio.
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Rybicki
authors.affiliation: Blood and Marrow Transplant Program, Cleveland Clinic Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Yurch
authors.affiliation: Blood and Marrow Transplant Program, Cleveland Clinic Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Jamie
authors.initials: J
authors.lastname: Starn
authors.affiliation: Blood and Marrow Transplant Program, Cleveland Clinic Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Christina
authors.initials: C
authors.lastname: Ferraro
authors.affiliation: Blood and Marrow Transplant Program, Cleveland Clinic Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Victoria
authors.initials: V
authors.lastname: Winslow
authors.affiliation: Blood and Marrow Transplant Program, Cleveland Clinic Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Betty K
authors.initials: BK
authors.lastname: Hamilton
authors.affiliation: Blood and Marrow Transplant Program, Cleveland Clinic Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Aaron T
authors.initials: AT
authors.lastname: Gerds
authors.affiliation: Blood and Marrow Transplant Program, Cleveland Clinic Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Hien
authors.initials: H
authors.lastname: Liu
authors.affiliation: Blood and Marrow Transplant Program, Cleveland Clinic Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Robert
authors.initials: R
authors.lastname: Dean
authors.affiliation: Blood and Marrow Transplant Program, Cleveland Clinic Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Brian T
authors.initials: BT
authors.lastname: Hill
authors.affiliation: Blood and Marrow Transplant Program, Cleveland Clinic Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Brad
authors.initials: B
authors.lastname: Pohlman
authors.affiliation: Blood and Marrow Transplant Program, Cleveland Clinic Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Steven
authors.initials: S
authors.lastname: Andresen
authors.affiliation: Pediatric Hematology/Oncology, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Rabi
authors.initials: R
authors.lastname: Hanna
authors.affiliation: Blood and Marrow Transplant Program, Cleveland Clinic Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Matt
authors.initials: M
authors.lastname: Kalaycio
authors.affiliation: Blood and Marrow Transplant Program, Cleveland Clinic Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Bolwell
authors.affiliation: Blood and Marrow Transplant Program, Cleveland Clinic Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Navneet S
authors.initials: NS
authors.lastname: Majhail
authors.affiliation: Blood and Marrow Transplant Program, Cleveland Clinic Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio. Electronic address: sobeckr@ccf.org.
authors.forename: Ronald M
authors.initials: RM
authors.lastname: Sobecks
mesh_terms: D000328:Adult; D000368:Aged; D002066:Busulfan / Q000627:therapeutic use; D017707:Erythrocyte Transfusion; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000401:mortality / Q000628:therapy*; D011788:Quality of Life; D012008:Recurrence; D016019:Survival Analysis; D019172:Transplantation Conditioning / Q000379:methods* / Q000592:standards; D014740:Vidarabine / Q000031:analogs & derivatives / Q000627:therapeutic use; D014916:Whole-Body Irradiation / Q000379:methods
chemical_list: D014740:Vidarabine; D002066:Busulfan; C024352:fludarabine
keywords: Acute myeloid leukemia; Allogeneic hematopoietic cell transplantation; Busulfan; Fludarabine; Myelodysplastic syndrome; Total body irradiation