Fludarabine/TBI 8 Gy versus fludarabine/treosulfan conditioning in patients with AML in first complete remission: a study from the Acute Leukemia Working Party of the EBMT

TY - JOUR

T1 - Fludarabine/TBI 8 Gy versus fludarabine/treosulfan conditioning in patients with AML in first complete remission: a study from the Acute Leukemia Working Party of the EBMT

AU - Bug, Gesine

AU - Labopin, Myriam

AU - Niittyvuopio, Riitta

AU - Stelljes, Matthias

AU - Reinhardt, Hans Christian

AU - Hilgendorf, Inken

AU - Kröger, Nicolaus

AU - Kaare, Ain

AU - Bethge, Wolfgang

AU - Schäfer-Eckart, Kerstin

AU - Verbeek, Mareike

AU - Mielke, Stephan

AU - Carlson, Kristina

AU - Bazarbachi, Ali

AU - Spyridonidis, Alexandros

AU - Savani, Bipin N

AU - Nagler, Arnon

AU - Mohty, Mohamad

N1 - © 2023. The Author(s).

PY - 2023/6

Y1 - 2023/6

N2 - The optimal reduced intensity conditioning (RIC) regimen is a matter of debate. We retrospectively compared conditioning with fludarabine plus fractionated total body irradiation of 8 Gy (FluTBI) and fludarabine plus treosulfan 30, 36 or 42 g/m2 (FluTreo) in 754 patients with AML above the age of 40 years undergoing an allogeneic hematopoietic stem cell transplant (HSCT) in first complete remission (CR). After balancing patient characteristics by propensity score matching of 115 patients in each group, FluTBI was associated with a significantly lower probability of relapse compared to FluTreo (18.3% vs. 34.7%, p = 0.018) which was counteracted by a higher non-relapse mortality (NRM, 16.8% vs. 5.3%, p = 0.02). Thus, overall survival and graft-versus-host disease-free and relapse-free survival at 2 years were similar between groups (OS 66.9% vs. 67.8%, GRFS 50.3% vs. 45.6%). Univariate analysis by age group demonstrated a higher NRM exclusively in patients ≥55 years of age treated with FluTBI compared to FluTreo (27.6% vs. 5.8%, p = 0.02), while a similarly low NRM was observed in patients <55 years in both groups (6.0% vs. 4.7%, p = ns). We conclude that both conditioning regimens are effective and safe, but FluTBI may better be reserved for younger patients below the age of 55 years.

AB - The optimal reduced intensity conditioning (RIC) regimen is a matter of debate. We retrospectively compared conditioning with fludarabine plus fractionated total body irradiation of 8 Gy (FluTBI) and fludarabine plus treosulfan 30, 36 or 42 g/m2 (FluTreo) in 754 patients with AML above the age of 40 years undergoing an allogeneic hematopoietic stem cell transplant (HSCT) in first complete remission (CR). After balancing patient characteristics by propensity score matching of 115 patients in each group, FluTBI was associated with a significantly lower probability of relapse compared to FluTreo (18.3% vs. 34.7%, p = 0.018) which was counteracted by a higher non-relapse mortality (NRM, 16.8% vs. 5.3%, p = 0.02). Thus, overall survival and graft-versus-host disease-free and relapse-free survival at 2 years were similar between groups (OS 66.9% vs. 67.8%, GRFS 50.3% vs. 45.6%). Univariate analysis by age group demonstrated a higher NRM exclusively in patients ≥55 years of age treated with FluTBI compared to FluTreo (27.6% vs. 5.8%, p = 0.02), while a similarly low NRM was observed in patients <55 years in both groups (6.0% vs. 4.7%, p = ns). We conclude that both conditioning regimens are effective and safe, but FluTBI may better be reserved for younger patients below the age of 55 years.

KW - Humans

KW - Adult

KW - Middle Aged

KW - Retrospective Studies

KW - Whole-Body Irradiation

KW - Busulfan/pharmacology

KW - Leukemia, Myeloid, Acute/therapy

KW - Acute Disease

KW - Vidarabine/pharmacology

KW - Recurrence

KW - Transplantation Conditioning

KW - Hematopoietic Stem Cell Transplantation

KW - Graft vs Host Disease

U2 - 10.1038/s41409-023-01965-x

DO - 10.1038/s41409-023-01965-x

M3 - SCORING: Journal article

C2 - 37002412

VL - 58

SP - 710

EP - 716

JO - BONE MARROW TRANSPL

JF - BONE MARROW TRANSPL

SN - 0268-3369

IS - 6

ER -