Reduced-intensity fludarabine/melphalan confers similar survival to busulfan/fludarabine myeloablative regimens for patients with acute myeloid leukemia and myelodysplasia

Elizabeth DiMaggio, Jun Min Zhou, Ryan Caddell, Rebecca Tombleson, Janelle Perkins, Claudio Anasetti, Farhad Khimani, Joseph Pidala, Taiga Nishihori, Lia Perez, Brian Betts, Hugo F. Fernandez, Asmita Mishra

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Optimal conditioning chemotherapy for patients with acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) remains uncertain. Myeloablative regimens such as fludarabine/busulfan are favored over reduced-intensity fludarabine/melphalan (Flu/Mel); however, it is not known if Flu/Mel is inferior. We analyzed hematopoietic cell transplantation recipients with AML and MDS who received fludarabine with once-daily intravenous busulfan targeted to either area under the curve (AUC) 5300 µM*L/min (Flu/Bu 5300) (n = 246) or AUC 3500 µM*L/min (Flu/Bu 3500) (n = 81), or Flu/Mel (n = 69). Flu/Bu regimens were compared separately to Flu/Mel. After 2-year follow-up, no differences in overall or relapse-free survival were found between Flu/Bu 5300 or 3500 versus Flu/Mel though relapse rates were significantly higher; 33.1% (p = 0.024), 44.6% (p = 0.002), versus 19.4%, respectively. Flu/Bu 5300 (p = 0.008) and Flu/Bu 3500 (p < 0.001) groups were prognostic for relapse compared to Flu/Mel. Flu/Mel yields lower relapse rates and similar survival benefit when compared to Flu/Bu 3500 or 5300 µM*L/min.

Original languageEnglish (US)
Pages (from-to)1678-1687
Number of pages10
JournalLeukemia and Lymphoma
Volume61
Issue number7
DOIs
StatePublished - Jun 6 2020

Keywords

  • Fludarabine
  • acute myeloid leukemia
  • busulfan
  • melphalan
  • myelodysplastic syndrome

PubMed: MeSH publication types

  • Journal Article

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