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

Ji Hyun Lee; Jimin Choi; Kyung A Kwon; Suee Lee; Sung Yong Oh; Hyuk-Chan Kwon; Hyo-Jin Kim; Jin Yeong Han; Sung-Hyun Kim

doi:10.5045/kjh.2010.45.2.102

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Original Article

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Korean J Hematol 2010; 45(2):

Published online June 30, 2010

https://doi.org/10.5045/kjh.2010.45.2.102

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

Ji Hyun Lee¹, Jimin Choi², Kyung A Kwon¹, Suee Lee¹, Sung Yong Oh¹, Hyuk-Chan Kwon¹, Hyo-Jin Kim¹, Jin Yeong Han³, and Sung-Hyun Kim^1,2*

Author Info. +

¹Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea.

²Clinical Research Center, Dong-A University Hospital, Busan, Korea.

³Department of Laboratory Medicine, Dong-A University College of Medicine, Busan, Korea.

Correspondence to : Correspondence to Sung-Hyun Kim, M.D., Ph.D. Department of Internal Medicine, Dong-A University College of Medicine, 3-1, Dongdaeshin-dong, Seo-gu, Busan 602-715, Korea. Tel: +82-51-240-2608, Fax: +82-51-240-2088, kshmoon@dau.ac.kr

Received: May 22, 2010; Revised: May 27, 2010; Accepted: May 31, 2010

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

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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.

Keywords Myeloablative regimen, Allogeneic hematopoietic stem cell transplantation, Fludarabine, Busulfan

Article

Original Article

Korean J Hematol 2010; 45(2): 102-108

Published online June 30, 2010 https://doi.org/10.5045/kjh.2010.45.2.102

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

Ji Hyun Lee¹, Jimin Choi², Kyung A Kwon¹, Suee Lee¹, Sung Yong Oh¹, Hyuk-Chan Kwon¹, Hyo-Jin Kim¹, Jin Yeong Han³, and Sung-Hyun Kim^1,2*

¹Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea.

²Clinical Research Center, Dong-A University Hospital, Busan, Korea.

³Department of Laboratory Medicine, Dong-A University College of Medicine, Busan, Korea.

Correspondence to: Correspondence to Sung-Hyun Kim, M.D., Ph.D. Department of Internal Medicine, Dong-A University College of Medicine, 3-1, Dongdaeshin-dong, Seo-gu, Busan 602-715, Korea. Tel: +82-51-240-2608, Fax: +82-51-240-2088, kshmoon@dau.ac.kr

Received: May 22, 2010; Revised: May 27, 2010; Accepted: May 31, 2010

Abstract

Background

Methods

Results

Conclusion

Keywords: Myeloablative regimen, Allogeneic hematopoietic stem cell transplantation, Fludarabine, Busulfan

Abstract

Fig 1.

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Figure 1.

Cumulative risk of relapse.

Blood Research 2010; 45: 102-108https://doi.org/10.5045/kjh.2010.45.2.102

Fig 2.

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Figure 2.

Overall survival (A) and event-free survival (B).

Blood Research 2010; 45: 102-108https://doi.org/10.5045/kjh.2010.45.2.102

Table 1 . Baseline patient characteristics..

Abbreviations: BuCy, busulfan-cyclophosphamide; BuFlu, busulfan-fludarabine; AML, acute myeloid leukemia; ALL, acute lymphocytic leukemia; MDS, myelodysplastic syndrome; CR, complete remission; BM, bone marrow; PB, peripheral blood; TNC, total nucleated cell; MNC, mononucleated cell..

Table 2 . Clinical outcomes in the BuCy and BuFlu groups..

Abbreviations: BuCy, busulfan-cyclophosphamide; BuFlu, busulfan-fludarabine; HVOD, hepatic veno-occlusive disease; GVHD, graft-versus-host disease; CMV, cytomegalovirus..

Table 3 . Cumulative risk of relapse..

Values are estimate (s.e.)..

Abbreviations: BuCy, busulfan-cyclophosphamide; BuFlu, busulfan-fludarabine..

Table 4 . Adjusted P=values of the groups (BuFlu vs. BuCy)..

Abbreviations: BuCy, busulfan-cyclophosphamide; BuFlu, busulfan-fludarabine; OS, overall survival; EFS, event-free survival; TNC, total nucleated cell; MNC, mononuclear cell..