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...

Overview

Journal Bone Marrow Transplant

Specialty General Surgery

Date 2023 Dec 1

PMID 38040842

Authors

Jesus Duque-Afonso

Jurgen Finke

Maud Ngoya

Jacques-Emmanuel Galimard

Charles Craddock

Kavita Raj

Adrian Bloor

Emma Nicholson

Matthias Eder

Orchard Kim

Thomas Valerius

John A Snowden

Eleni Tholouli

Charles Crawley

Matthew Collin

Keith M O Wilson

Alain Gadisseur

Rachel Protheroe

Eva Maria Wagner-Drouet

Bipin N Savani

Alexandros Spyridonidis

Fabio Ciceri

Arnon Nagler

Mohamad Mohty

Affiliations

Soon will be listed here.

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 (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. 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.

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