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Feasibility of non-TBI conditioning with busulfan and fludarabine for allogeneic stem cell transplantation in lymphoid malignancy.

Shin HC, Lee YJ, Moon JH, Lee SJ, Kang BW, Chae YS, Kim JG, Choi JY, Seo JW, Kim YK, Suh JS, Sohn SK - Korean J. Intern. Med. (2012)

Bottom Line: Treatment-related mortality (TRM) was significantly lower in the BuFlu group (16.9%) than in the BuCy2 group (57.1%, p = 0.010).In multivariate analyses, the BuFlu regimen was identified as an independent favorable risk factor for TRM (hazard ratio [HR], 0.036; p = 0.017) and extensive chronic GVHD (HR, 0.168; p = 0.034).It was safely administered with a lower TRM rate than BuCy2 conditioning.

View Article: PubMed Central - PubMed

Affiliation: Department of Hematology/Oncology, Kyungpook National University Hospital, Daegu, Korea.

ABSTRACT

Background/aims: This retrospective study evaluated the transplantation outcomes of patients with adult lymphoid malignancies who received chemotherapy-based conditioning with busulfan and fludarabine (BuFlu) and busulfan and cyclophosphamide (BuCy2).

Methods: Thirty-eight patients (34 with acute lymphoblastic leukemia and 4 with lymphoblastic lymphoma) were included in the current study. The conditioning regimen was BuCy2 for 14 patients and BuFlu for the remaining 24 patients. Eight and 13 patients were high risk disease in the BuCy2 and BuFlu groups, respectively.

Results: The cumulative incidence of grade II-IV acute graft-versus-host disease (GVHD) was 56.5% and 55.2% and that of extensive chronic GVHD 17.0% and 55.6% (p = 0.018) for the BuFlu and BuCy2 groups, respectively. The 3-year relapse rate was 27.8% and 31.4% and 3-year overall survival 34.3% and 46.8% for the BuFlu and BuCy2 groups, respectively. Treatment-related mortality (TRM) was significantly lower in the BuFlu group (16.9%) than in the BuCy2 group (57.1%, p = 0.010). In multivariate analyses, the BuFlu regimen was identified as an independent favorable risk factor for TRM (hazard ratio [HR], 0.036; p = 0.017) and extensive chronic GVHD (HR, 0.168; p = 0.034).

Conclusions: Our BuFlu regimen would appear to be an acceptable conditioning option for lymphoid malignancies, including high-risk diseases. It was safely administered with a lower TRM rate than BuCy2 conditioning.

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Related in: MedlinePlus

Survival rates according to risk group and presence of graft-versus-host disease (GVHD). (A) Overall survival according to risk group. The 3-year overall survival (OS) rate was 53.8% (95% confidence interval, 33.7 to 86.0) for standard-risk patients and 30.6% (95% confidence interval, 14.3 to 65.1) for high-risk patients. (B) Overall survival according to presence of chronic GVHD. Patients with chronic GVHD showed a better 3-year OS rate (64.0%) than those without chronic GVHD (24.0%).
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Figure 1: Survival rates according to risk group and presence of graft-versus-host disease (GVHD). (A) Overall survival according to risk group. The 3-year overall survival (OS) rate was 53.8% (95% confidence interval, 33.7 to 86.0) for standard-risk patients and 30.6% (95% confidence interval, 14.3 to 65.1) for high-risk patients. (B) Overall survival according to presence of chronic GVHD. Patients with chronic GVHD showed a better 3-year OS rate (64.0%) than those without chronic GVHD (24.0%).

Mentions: The survival rate for all patients at 3 years was 41.8% (95% confidence interval [CI], 27.5 to 63.4) with a median follow-up duration of 982 days (95% CI, 634 to 1,329). The 3-year OS rate was 53.8% (95% CI, 33.7 to 86.0) for standard-risk patients and 30.6% (95% CI, 14.3 to 65.1) for the high-risk patients (p = 0.213) (Fig. 1), while the 3-year relapse rate was 14.7% for the standard-risk patients and 43.3% for the high-risk patients (p = 0.109). Patients with chronic GVHD had a better 3-year OS rate (64.0%) than those without chronic GVHD (24.0%, p = 0.002) (Fig. 1). The 3-year OS for the BuCy2 and BuFlu groups was 34.3% and 46.8%, respectively (p = 0.279) (Fig. 2), while the 3-year event-free survival (EFS) rate was 25.7% and 47.1%, respectively (p = 0.215) (Fig. 2). Relapse occurred in three patients (21.4%) in the BuCy2 group and six patients (25.0%) in the BuFlu group (p = 0.803) (Table 2). The cumulative incidence of 3-year relapse for the BuCy2 and BuFlu groups was 27.8% and 31.4%, respectively (p = 0.476) (Fig. 3).


Feasibility of non-TBI conditioning with busulfan and fludarabine for allogeneic stem cell transplantation in lymphoid malignancy.

Shin HC, Lee YJ, Moon JH, Lee SJ, Kang BW, Chae YS, Kim JG, Choi JY, Seo JW, Kim YK, Suh JS, Sohn SK - Korean J. Intern. Med. (2012)

Survival rates according to risk group and presence of graft-versus-host disease (GVHD). (A) Overall survival according to risk group. The 3-year overall survival (OS) rate was 53.8% (95% confidence interval, 33.7 to 86.0) for standard-risk patients and 30.6% (95% confidence interval, 14.3 to 65.1) for high-risk patients. (B) Overall survival according to presence of chronic GVHD. Patients with chronic GVHD showed a better 3-year OS rate (64.0%) than those without chronic GVHD (24.0%).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC3295992&req=5

Figure 1: Survival rates according to risk group and presence of graft-versus-host disease (GVHD). (A) Overall survival according to risk group. The 3-year overall survival (OS) rate was 53.8% (95% confidence interval, 33.7 to 86.0) for standard-risk patients and 30.6% (95% confidence interval, 14.3 to 65.1) for high-risk patients. (B) Overall survival according to presence of chronic GVHD. Patients with chronic GVHD showed a better 3-year OS rate (64.0%) than those without chronic GVHD (24.0%).
Mentions: The survival rate for all patients at 3 years was 41.8% (95% confidence interval [CI], 27.5 to 63.4) with a median follow-up duration of 982 days (95% CI, 634 to 1,329). The 3-year OS rate was 53.8% (95% CI, 33.7 to 86.0) for standard-risk patients and 30.6% (95% CI, 14.3 to 65.1) for the high-risk patients (p = 0.213) (Fig. 1), while the 3-year relapse rate was 14.7% for the standard-risk patients and 43.3% for the high-risk patients (p = 0.109). Patients with chronic GVHD had a better 3-year OS rate (64.0%) than those without chronic GVHD (24.0%, p = 0.002) (Fig. 1). The 3-year OS for the BuCy2 and BuFlu groups was 34.3% and 46.8%, respectively (p = 0.279) (Fig. 2), while the 3-year event-free survival (EFS) rate was 25.7% and 47.1%, respectively (p = 0.215) (Fig. 2). Relapse occurred in three patients (21.4%) in the BuCy2 group and six patients (25.0%) in the BuFlu group (p = 0.803) (Table 2). The cumulative incidence of 3-year relapse for the BuCy2 and BuFlu groups was 27.8% and 31.4%, respectively (p = 0.476) (Fig. 3).

Bottom Line: Treatment-related mortality (TRM) was significantly lower in the BuFlu group (16.9%) than in the BuCy2 group (57.1%, p = 0.010).In multivariate analyses, the BuFlu regimen was identified as an independent favorable risk factor for TRM (hazard ratio [HR], 0.036; p = 0.017) and extensive chronic GVHD (HR, 0.168; p = 0.034).It was safely administered with a lower TRM rate than BuCy2 conditioning.

View Article: PubMed Central - PubMed

Affiliation: Department of Hematology/Oncology, Kyungpook National University Hospital, Daegu, Korea.

ABSTRACT

Background/aims: This retrospective study evaluated the transplantation outcomes of patients with adult lymphoid malignancies who received chemotherapy-based conditioning with busulfan and fludarabine (BuFlu) and busulfan and cyclophosphamide (BuCy2).

Methods: Thirty-eight patients (34 with acute lymphoblastic leukemia and 4 with lymphoblastic lymphoma) were included in the current study. The conditioning regimen was BuCy2 for 14 patients and BuFlu for the remaining 24 patients. Eight and 13 patients were high risk disease in the BuCy2 and BuFlu groups, respectively.

Results: The cumulative incidence of grade II-IV acute graft-versus-host disease (GVHD) was 56.5% and 55.2% and that of extensive chronic GVHD 17.0% and 55.6% (p = 0.018) for the BuFlu and BuCy2 groups, respectively. The 3-year relapse rate was 27.8% and 31.4% and 3-year overall survival 34.3% and 46.8% for the BuFlu and BuCy2 groups, respectively. Treatment-related mortality (TRM) was significantly lower in the BuFlu group (16.9%) than in the BuCy2 group (57.1%, p = 0.010). In multivariate analyses, the BuFlu regimen was identified as an independent favorable risk factor for TRM (hazard ratio [HR], 0.036; p = 0.017) and extensive chronic GVHD (HR, 0.168; p = 0.034).

Conclusions: Our BuFlu regimen would appear to be an acceptable conditioning option for lymphoid malignancies, including high-risk diseases. It was safely administered with a lower TRM rate than BuCy2 conditioning.

Show MeSH
Related in: MedlinePlus