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Comparison of fludarabine/melphalan (FluMel) with fludarabine/melphalan/BCNU or thiotepa (FBM/FTM) in patients with AML in first complete remission undergoing allogeneic hematopoietic stem cell transplantation - a registry study on behalf of the EBMT acute leukemia working party
Duque-Afonso, J. Finke, J. Ngoya, M. Galimard, J. E. Craddock, C. Raj, K. Bloor, Adrian Nicholson, E. Eder, M. Kim, O.
Duque-Afonso, J.
Finke, J.
Ngoya, M.
Galimard, J. E.
Craddock, C.
Raj, K.
Bloor, Adrian
Nicholson, E.
Eder, M.
Kim, O.
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Abstract
Conditioning protocols for patients undergoing allogeneic hematopoietic cell transplantation (allo-HCT) are being developed continuously to improve their anti-leukemic efficacy and reduce their toxicity. In this study, we compared the conditioning protocol of fludarabine with melphalan 140 mg/m(2) (FluMel) with conditioning protocols based on this same backbone but with an additional alkylating agent i.e., either fludarabine/BCNU (also known as carmustine)/melphalan (FBM), or fludarabine/thiotepa/melphalan (FTM) 110 mg/m(2). We included 1272 adult patients (FluMel, n = 1002; FBM/FTM, n = 270) with acute myeloid leukemia (AML) with intermediate/poor cytogenetic risk in first complete remission (CR) from the registry of the EBMT Acute Leukemia Working Party. Despite patients in the FBM/FTM group were older (64.1 years vs. 59.8 years, p < 0.001) and had a worse Karnofsky performance score (KPS < 90, 33% vs. 24%, p = 0.003), they showed a better overall survival (OS) (2 y OS: 68.3% vs. 58.1%, p = 0.02) and less non-relapse mortality (NRM) (2 y NRM: 15.8% vs. 22.2%, p = 0.009) compared to patients treated with FluMel. No significant differences were observed in relapse incidence (RI) (2 y RI: 24.9% vs. 23.7%, p = 0.62). In conclusion, the addition of a second alkylating agent (BCNU/carmustine or thiotepa) to FluMel as FBM/FTM conditioning, improves OS in AML patients in first CR with intermediate/poor risk cytogenetics after allo-HCT.
Authors
Duque-Afonso, J.
Finke, J.
Ngoya, M.
Galimard, J. E.
Craddock, C.
Raj, K.
Bloor, Adrian
Nicholson, E.
Eder, M.
Kim, O.
Valerius, T.
Snowden, J. A.
Tholouli, E.
Crawley, C.
Collin, M.
Wilson, K. M. O.
Gadisseur, A.
Protheroe, R.
Wagner-Drouet, E. M.
Savani, B. N.
Spyridonidis, A.
Ciceri, F.
Nagler, A.
Mohty, M.
Finke, J.
Ngoya, M.
Galimard, J. E.
Craddock, C.
Raj, K.
Bloor, Adrian
Nicholson, E.
Eder, M.
Kim, O.
Valerius, T.
Snowden, J. A.
Tholouli, E.
Crawley, C.
Collin, M.
Wilson, K. M. O.
Gadisseur, A.
Protheroe, R.
Wagner-Drouet, E. M.
Savani, B. N.
Spyridonidis, A.
Ciceri, F.
Nagler, A.
Mohty, M.
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Date
2023
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Article
Citation
Duque-Afonso J, Finke J, Ngoya M, Galimard JE, Craddock C, Raj K, et al. Comparison of fludarabine/melphalan (FluMel) with fludarabine/melphalan/BCNU or thiotepa (FBM/FTM) in patients with AML in first complete remission undergoing allogeneic hematopoietic stem cell transplantation - a registry study on behalf of the EBMT Acute Leukemia Working Party. Bone marrow transplantation. 2023 Dec 2. PubMed PMID: 38040842. Epub 2023/12/02. eng.