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Fludarabine-based myeloablative regimen as pretransplant conditioning therapy in adult acute leukemia/myelodysplastic syndrome: comparison with oral or intravenous busulfan with cyclophosphamide.

Lee JH, Choi J, Kwon KA, Lee S, Oh SY, Kwon HC, Kim HJ, Han JY, Kim SH - Korean J Hematol (2010)

Bottom Line: Recent studies postulate that fludarabine (Flu) is a less toxic substitute for Cy.The BuFlu group showed a lower incidence of mucositis (P=0.005), but there was no significant intergroup difference in the time of engraftment, nausea/vomiting, acute/chronic graft-versus-host disease, hepatic veno-occlusive disease, or hemorrhagic cystitis.Moreover, the 2 groups showed no significant difference in the cumulative risk of relapse, event-free survival, or overall survival.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea.

ABSTRACT

Background: A combination of busulfan (Bu) and cyclophosphamide (Cy) has been used as a standard myeloablative regimen for allogeneic hematopoietic stem cell transplantation (HSCT). Recent studies postulate that fludarabine (Flu) is a less toxic substitute for Cy.

Methods: Forty-two patients who were diagnosed with acute leukemia or myelodysplastic syndrome and received BuFlu (n=17) or BuCy (n=25) from August, 1999 to July, 2009 at Dong-A University Medical Center were retrospectively analyzed.

Results: The median follow-up duration was 39.75 months. The BuFlu group showed a lower incidence of mucositis (P=0.005), but there was no significant intergroup difference in the time of engraftment, nausea/vomiting, acute/chronic graft-versus-host disease, hepatic veno-occlusive disease, or hemorrhagic cystitis. Moreover, the 2 groups showed no significant difference in the cumulative risk of relapse, event-free survival, or overall survival.

Conclusion: BuFlu administration can be employed as a preparative regimen for allogeneic HSCT and shows efficacy and transplant-adverse effects comparable to those of BuCy. However, randomized prospective studies in more patients are warranted.

No MeSH data available.


Related in: MedlinePlus

Overall survival (A) and event-free survival (B).
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Figure 2: Overall survival (A) and event-free survival (B).

Mentions: There were no significant intergroup differences in OS and EFS (P=0.86 and P=0.79, respectively) (Fig. 2). In the BuCy group, the 3-year OS and EFS were 64% (s.e.=10%) and 64% (s.e.=10%), respectively. In the BuFlu group, the 3-year OS and EFS were 58% (s.e.=13%) and 55% (s.e.=13%), respectively. In the univariate analysis, none of the variables was found to affect OS and EFS. The multivariate analysis showed that the TNC count was associated with good OS and EFS (HR=0.59; 95% CI, 0.40-0.88; P=0.009 and HR=0.69; 95% CI, 0.50-0.96; P=0.026, respectively), whereas the CD34+ cell count was marginally associated with poor OS (HR=1.34; 95% CI, 1.01-1.78; P=0.045). The adjusted P=values for stem cell source, donor type, and number of infused cells are shown in Table 4.


Fludarabine-based myeloablative regimen as pretransplant conditioning therapy in adult acute leukemia/myelodysplastic syndrome: comparison with oral or intravenous busulfan with cyclophosphamide.

Lee JH, Choi J, Kwon KA, Lee S, Oh SY, Kwon HC, Kim HJ, Han JY, Kim SH - Korean J Hematol (2010)

Overall survival (A) and event-free survival (B).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2983027&req=5

Figure 2: Overall survival (A) and event-free survival (B).
Mentions: There were no significant intergroup differences in OS and EFS (P=0.86 and P=0.79, respectively) (Fig. 2). In the BuCy group, the 3-year OS and EFS were 64% (s.e.=10%) and 64% (s.e.=10%), respectively. In the BuFlu group, the 3-year OS and EFS were 58% (s.e.=13%) and 55% (s.e.=13%), respectively. In the univariate analysis, none of the variables was found to affect OS and EFS. The multivariate analysis showed that the TNC count was associated with good OS and EFS (HR=0.59; 95% CI, 0.40-0.88; P=0.009 and HR=0.69; 95% CI, 0.50-0.96; P=0.026, respectively), whereas the CD34+ cell count was marginally associated with poor OS (HR=1.34; 95% CI, 1.01-1.78; P=0.045). The adjusted P=values for stem cell source, donor type, and number of infused cells are shown in Table 4.

Bottom Line: Recent studies postulate that fludarabine (Flu) is a less toxic substitute for Cy.The BuFlu group showed a lower incidence of mucositis (P=0.005), but there was no significant intergroup difference in the time of engraftment, nausea/vomiting, acute/chronic graft-versus-host disease, hepatic veno-occlusive disease, or hemorrhagic cystitis.Moreover, the 2 groups showed no significant difference in the cumulative risk of relapse, event-free survival, or overall survival.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea.

ABSTRACT

Background: A combination of busulfan (Bu) and cyclophosphamide (Cy) has been used as a standard myeloablative regimen for allogeneic hematopoietic stem cell transplantation (HSCT). Recent studies postulate that fludarabine (Flu) is a less toxic substitute for Cy.

Methods: Forty-two patients who were diagnosed with acute leukemia or myelodysplastic syndrome and received BuFlu (n=17) or BuCy (n=25) from August, 1999 to July, 2009 at Dong-A University Medical Center were retrospectively analyzed.

Results: The median follow-up duration was 39.75 months. The BuFlu group showed a lower incidence of mucositis (P=0.005), but there was no significant intergroup difference in the time of engraftment, nausea/vomiting, acute/chronic graft-versus-host disease, hepatic veno-occlusive disease, or hemorrhagic cystitis. Moreover, the 2 groups showed no significant difference in the cumulative risk of relapse, event-free survival, or overall survival.

Conclusion: BuFlu administration can be employed as a preparative regimen for allogeneic HSCT and shows efficacy and transplant-adverse effects comparable to those of BuCy. However, randomized prospective studies in more patients are warranted.

No MeSH data available.


Related in: MedlinePlus