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, Jesus; Finke, Juergen; Ngoya, Maud; Galimard, Jacques-Emmanuel; Craddock, Charles; Raj, Kavita; Bloor, Adrian; Nicholson, Emma; Eder, Matthias; Kim, Orchard; Valerius, Thomas; Snowden, John A.; Tholouli, Eleni; Crawley, Charles; Collin, Matthew; Wilson, Keith M.O.; Gadisseur, Alain; Protheroe, Rachel; Wagner-Drouet, Eva Maria; Savani, Bipin N.; Spyridonidis, Alexandros; Ciceri, Fabio; Nagler, Arnon; Mohty, Mohamad

doi:10.1038/S41409-023-02150-W

Title

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

Author

Duque-Afonso, Jesus

Finke, Juergen

Ngoya, Maud

Galimard, Jacques-Emmanuel

Craddock, Charles

Raj, Kavita

Bloor, Adrian

Nicholson, Emma

Eder, Matthias

Kim, Orchard

Valerius, Thomas

Snowden, John A.

Tholouli, Eleni

Crawley, Charles

Collin, Matthew

Wilson, Keith M.O.

Gadisseur, Alain

Protheroe, Rachel

Wagner-Drouet, Eva Maria

Savani, Bipin N.

More...

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.

Language

English

Source (journal)

Bone marrow transplantation. - Basingstoke

Publication

London : Springernature , 2024

ISSN

0268-3369

DOI

10.1038/S41409-023-02150-W

Volume/pages

59 :2 (2024) , p. 247-254