Higher busulfan dose intensity appears to improve leukemia-free and overall survival in AML allografted in CR2: An analysis from the Acute Leukemia Working Party of the European Group for Blood and Marrow Transplantation.

Date publication

septembre 2015

Journal

Leukemia research

Auteurs

Membres identifiés du Cancéropôle Est :
Dr LIOURE Bruno

Tous les auteurs :
Kharfan-Dabaja MA, Labopin M, Bazarbachi A, Socie G, Kroeger N, Blaise D, Veelken H, Bermudez A, Or R, Lioure B, Beelen D, Fegueux N, Hamladji RM, Nagler A, Mohty M

Lien Pubmed

https://www.ncbi.nlm.nih.gov/pubmed/26003666

Résumé

Allogeneic hematopoietic cell transplantation is a potentially curative treatment in patients with acute myeloid leukemia. Recent advances in the field of hematopoietic cell allografting have resulted in a practice shift, favoring less intense preparative regimens. We present results of a retrospective comparative analysis of two preparative regimens, namely FB2 (IV fludarabine plus IV busulfan 6.4mg/kg±10%) and FB4 (IV fludarabine plus IV busulfan 12.8mg/kg ±10%), in patients with acute myeloid leukemia undergoing hematopoietic cell allografting in second complete remission at EBMT participating centers. Between 2003 and 2010, 128 AML patients in second complete remission were allografted following a preparative regimen of FB2 (n=88) or FB4 (n=40). The median time-to-neutrophil engraftment was similar whether patients received FB2 (16 (5-38) days) or FB4 (16 (9-29) days), p=0.45. A multivariate analysis showed that use of FB4 resulted in improved 2-year leukemia-free (HR=0.44 (95%CI=0.21, 0.94), p=0.03) and overall survival (HR=0.38 (95%CI=0.16, 0.86), p=0.02). Cumulative incidence of non-relapse mortality (2-year) for all patients was 21% (95%CI=14-28%). Our analysis suggests that FB4 improves 2-year leukemia-free and overall survival in AML allografted in second complete remission. A confirmatory randomized controlled trial that compares these two preparative regimens (FB2 vs. FB4) in AML in CR2 is definitely warranted.

Mots clés

Adult, Aged, Antineoplastic Agents, Alkylating, therapeutic use, Busulfan, therapeutic use, Female, Graft vs Host Disease, immunology, Hematopoietic Stem Cell Transplantation, Humans, Leukemia, Myeloid, Acute, drug therapy, Male, Middle Aged, Multivariate Analysis, Randomized Controlled Trials as Topic, Remission Induction, Retrospective Studies, Survival Analysis, Transplantation Conditioning, methods, Transplantation, Homologous, Vidarabine, analogs & derivatives

Référence

Leuk. Res.. 2015 Sep;39(9):933-7