Fractionated busulfan myeloablative conditioning improves survival in older patients with acute myeloid leukemia and myelodysplastic syndrome
Background A myeloablative conditioning regimen can be safely given to older patients and those with comorbidities without increasing nonrelapse mortality (NRM) by fractionating the dose of intravenous busulfan. How this approach compares in efficacy with traditional, nonfractionated, lower dose reg...
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| Veröffentlicht in: | Cancer 2021-05, Vol.127 (10), p.1598-1605 |
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| creator | Oran, Betül Saliba, Rima M. Mehta, Rohtesh S. Alousi, Amin M. Marin, David Valdez, Ben C. Chen, Julianne Bashir, Qaiser Ciurea, Stefan O. Olson, Amanda L. Hosing, Chitra Kebriaei, Partow Rezvani, Katy Shpall, Elizabeth J. Champlin, Richard E. Andersson, Borje S. Popat, Uday R. |
| description | Background
A myeloablative conditioning regimen can be safely given to older patients and those with comorbidities without increasing nonrelapse mortality (NRM) by fractionating the dose of intravenous busulfan. How this approach compares in efficacy with traditional, nonfractionated, lower dose regimens is unknown.
Methods
Outcomes were compared in patients with acute myeloid leukemia (AML) or myelodysplastic syndrome who received either myeloablative, fractionated busulfan (f‐Bu) dosed to achieve an area under the curve of 20,000 μmol per minute (f‐Bu20K) over 2 weeks (n = 84) or a standard, nonfractionated, lower busulfan dose regimen of 16,000 μmol per minute (Bu16K) over 4 days (n = 78). Both groups also received fludarabine 40 mg/m2 intravenously for 4 days. Graft‐versus‐host disease prophylaxis was tacrolimus and methotrexate. Patients in the Bu16K group who had unrelated donors also received antithymocyte globulin. The primary endpoint was progression‐free survival.
Results
Roughly one‐half of the patients were aged >65 years, approximately 40% had poor‐risk cytogenetics, approximately 40% of those with AML were not in complete remission, and approximately 40% had a comorbidity index >3. At 2 years, progression‐free survival was significantly improved in the f‐Bu20K group compared with the Bu16K group (45% vs 24%, respectively; hazard ratio [HR], 0.6; 95% CI, 0.4‐0.8; P = .004). This was because of a significant reduction in progression (34% vs 59%, respectively; HR, 0.5; 95% CI, 0.3‐0.8; P = .003) without any increase in NRM (21% vs 15%, respectively; HR, 1.4; 95% CI, 0.7‐3; P = .3), which resulted in improved overall survival (51% vs 31%, respectively; HR, 0.6; 95% CI, 0.3‐0.9; P = .01).
Conclusions
A myeloablative, fractionated busulfan regimen reduces relapse and improves survival without increasing NRM in older patients with AML and myelodysplastic syndrome.
A myeloablative, fractionated regimen of busulfan reduces relapse and improves survival without increasing nonrelapse mortality in older patients with acute myeloid leukemia and myelodysplastic syndrome. |
| doi_str_mv | 10.1002/cncr.33383 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2479709321</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2479709321</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3933-51fb877c62f5c27bb9327656959a0de6d85d414ac24731c374d06978477c3e983</originalsourceid><addsrcrecordid>eNp9kc-KFDEQh4Mo7rh68QEk4EWEXvOvO52jDLsqLAqi4K1JJ9WaNZ2MSWeWfgjf2Yy9evDgqajiq48qfgg9peSCEsJemWDSBee85_fQjhIlG0IFu492hJC-aQX_coYe5XxTW8la_hCdcS4kVYLv0M-rpM3iYtALWDyWXPykA55X8FGPXi_uCNjEYN0JcuErdvMhxSNknEs6uqP22AUcvYWEDxWHsGR865ZvWJuywGZyFnso32F2Gutgt6Fd88HrvDiD8xpsijM8Rg8m7TM8uavn6PPV5af92-b6w5t3-9fXjeGK86al09hLaTo2tYbJcVScya7tVKs0sdDZvrWCCm2YkJwaLoUlnZK9qDscVM_P0YvNW1_5USAvw-yyAe91gFjyUPeUJNVKK_r8H_QmlhTqdQNrqeKSCUUq9XKjTIo5J5iGQ3KzTutAyXAKaTiFNPwOqcLP7pRlnMH-Rf-kUgG6AbfOw_of1bB_v_-4SX8Bw-KfVQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2519372490</pqid></control><display><type>article</type><title>Fractionated busulfan myeloablative conditioning improves survival in older patients with acute myeloid leukemia and myelodysplastic syndrome</title><source>MEDLINE</source><source>Access via Wiley Online Library</source><source>EZB-FREE-00999 freely available EZB journals</source><source>Wiley Online Library (Open Access Collection)</source><source>Alma/SFX Local Collection</source><creator>Oran, Betül ; Saliba, Rima M. ; Mehta, Rohtesh S. ; Alousi, Amin M. ; Marin, David ; Valdez, Ben C. ; Chen, Julianne ; Bashir, Qaiser ; Ciurea, Stefan O. ; Olson, Amanda L. ; Hosing, Chitra ; Kebriaei, Partow ; Rezvani, Katy ; Shpall, Elizabeth J. ; Champlin, Richard E. ; Andersson, Borje S. ; Popat, Uday R.</creator><creatorcontrib>Oran, Betül ; Saliba, Rima M. ; Mehta, Rohtesh S. ; Alousi, Amin M. ; Marin, David ; Valdez, Ben C. ; Chen, Julianne ; Bashir, Qaiser ; Ciurea, Stefan O. ; Olson, Amanda L. ; Hosing, Chitra ; Kebriaei, Partow ; Rezvani, Katy ; Shpall, Elizabeth J. ; Champlin, Richard E. ; Andersson, Borje S. ; Popat, Uday R.</creatorcontrib><description>Background
A myeloablative conditioning regimen can be safely given to older patients and those with comorbidities without increasing nonrelapse mortality (NRM) by fractionating the dose of intravenous busulfan. How this approach compares in efficacy with traditional, nonfractionated, lower dose regimens is unknown.
Methods
Outcomes were compared in patients with acute myeloid leukemia (AML) or myelodysplastic syndrome who received either myeloablative, fractionated busulfan (f‐Bu) dosed to achieve an area under the curve of 20,000 μmol per minute (f‐Bu20K) over 2 weeks (n = 84) or a standard, nonfractionated, lower busulfan dose regimen of 16,000 μmol per minute (Bu16K) over 4 days (n = 78). Both groups also received fludarabine 40 mg/m2 intravenously for 4 days. Graft‐versus‐host disease prophylaxis was tacrolimus and methotrexate. Patients in the Bu16K group who had unrelated donors also received antithymocyte globulin. The primary endpoint was progression‐free survival.
Results
Roughly one‐half of the patients were aged >65 years, approximately 40% had poor‐risk cytogenetics, approximately 40% of those with AML were not in complete remission, and approximately 40% had a comorbidity index >3. At 2 years, progression‐free survival was significantly improved in the f‐Bu20K group compared with the Bu16K group (45% vs 24%, respectively; hazard ratio [HR], 0.6; 95% CI, 0.4‐0.8; P = .004). This was because of a significant reduction in progression (34% vs 59%, respectively; HR, 0.5; 95% CI, 0.3‐0.8; P = .003) without any increase in NRM (21% vs 15%, respectively; HR, 1.4; 95% CI, 0.7‐3; P = .3), which resulted in improved overall survival (51% vs 31%, respectively; HR, 0.6; 95% CI, 0.3‐0.9; P = .01).
Conclusions
A myeloablative, fractionated busulfan regimen reduces relapse and improves survival without increasing NRM in older patients with AML and myelodysplastic syndrome.
A myeloablative, fractionated regimen of busulfan reduces relapse and improves survival without increasing nonrelapse mortality in older patients with acute myeloid leukemia and myelodysplastic syndrome.</description><identifier>ISSN: 0008-543X</identifier><identifier>EISSN: 1097-0142</identifier><identifier>DOI: 10.1002/cncr.33383</identifier><identifier>PMID: 33471943</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Acute myeloid leukemia ; acute myeloid leukemia (AML) ; Aged ; Antilymphocyte serum ; Busulfan ; Busulfan - administration & dosage ; Conditioning ; Cytogenetics ; Dosage ; Fludarabine ; fractionated ; Fractionation ; Globulins ; Humans ; Intravenous administration ; Leukemia ; Leukemia, Myeloid, Acute - drug therapy ; Leukemia, Myeloid, Acute - mortality ; Methotrexate ; myeloablative ; Myeloablative Agonists - administration & dosage ; Myelodysplastic syndrome ; myelodysplastic syndrome (MDS) ; Myelodysplastic Syndromes - drug therapy ; Myelodysplastic Syndromes - mortality ; Myeloid leukemia ; Oncology ; Prophylaxis ; Remission ; Survival ; Survival Analysis ; Tacrolimus ; Thymocytes ; Transplantation Conditioning ; Treatment Outcome</subject><ispartof>Cancer, 2021-05, Vol.127 (10), p.1598-1605</ispartof><rights>2021 American Cancer Society</rights><rights>2021 American Cancer Society.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3933-51fb877c62f5c27bb9327656959a0de6d85d414ac24731c374d06978477c3e983</citedby><cites>FETCH-LOGICAL-c3933-51fb877c62f5c27bb9327656959a0de6d85d414ac24731c374d06978477c3e983</cites><orcidid>0000-0002-7592-2224 ; 0000-0002-8532-544X ; 0000-0003-1264-5968 ; 0000-0001-8597-3271</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fcncr.33383$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fcncr.33383$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,1433,27924,27925,45574,45575,46409,46833</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33471943$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Oran, Betül</creatorcontrib><creatorcontrib>Saliba, Rima M.</creatorcontrib><creatorcontrib>Mehta, Rohtesh S.</creatorcontrib><creatorcontrib>Alousi, Amin M.</creatorcontrib><creatorcontrib>Marin, David</creatorcontrib><creatorcontrib>Valdez, Ben C.</creatorcontrib><creatorcontrib>Chen, Julianne</creatorcontrib><creatorcontrib>Bashir, Qaiser</creatorcontrib><creatorcontrib>Ciurea, Stefan O.</creatorcontrib><creatorcontrib>Olson, Amanda L.</creatorcontrib><creatorcontrib>Hosing, Chitra</creatorcontrib><creatorcontrib>Kebriaei, Partow</creatorcontrib><creatorcontrib>Rezvani, Katy</creatorcontrib><creatorcontrib>Shpall, Elizabeth J.</creatorcontrib><creatorcontrib>Champlin, Richard E.</creatorcontrib><creatorcontrib>Andersson, Borje S.</creatorcontrib><creatorcontrib>Popat, Uday R.</creatorcontrib><title>Fractionated busulfan myeloablative conditioning improves survival in older patients with acute myeloid leukemia and myelodysplastic syndrome</title><title>Cancer</title><addtitle>Cancer</addtitle><description>Background
A myeloablative conditioning regimen can be safely given to older patients and those with comorbidities without increasing nonrelapse mortality (NRM) by fractionating the dose of intravenous busulfan. How this approach compares in efficacy with traditional, nonfractionated, lower dose regimens is unknown.
Methods
Outcomes were compared in patients with acute myeloid leukemia (AML) or myelodysplastic syndrome who received either myeloablative, fractionated busulfan (f‐Bu) dosed to achieve an area under the curve of 20,000 μmol per minute (f‐Bu20K) over 2 weeks (n = 84) or a standard, nonfractionated, lower busulfan dose regimen of 16,000 μmol per minute (Bu16K) over 4 days (n = 78). Both groups also received fludarabine 40 mg/m2 intravenously for 4 days. Graft‐versus‐host disease prophylaxis was tacrolimus and methotrexate. Patients in the Bu16K group who had unrelated donors also received antithymocyte globulin. The primary endpoint was progression‐free survival.
Results
Roughly one‐half of the patients were aged >65 years, approximately 40% had poor‐risk cytogenetics, approximately 40% of those with AML were not in complete remission, and approximately 40% had a comorbidity index >3. At 2 years, progression‐free survival was significantly improved in the f‐Bu20K group compared with the Bu16K group (45% vs 24%, respectively; hazard ratio [HR], 0.6; 95% CI, 0.4‐0.8; P = .004). This was because of a significant reduction in progression (34% vs 59%, respectively; HR, 0.5; 95% CI, 0.3‐0.8; P = .003) without any increase in NRM (21% vs 15%, respectively; HR, 1.4; 95% CI, 0.7‐3; P = .3), which resulted in improved overall survival (51% vs 31%, respectively; HR, 0.6; 95% CI, 0.3‐0.9; P = .01).
Conclusions
A myeloablative, fractionated busulfan regimen reduces relapse and improves survival without increasing NRM in older patients with AML and myelodysplastic syndrome.
A myeloablative, fractionated regimen of busulfan reduces relapse and improves survival without increasing nonrelapse mortality in older patients with acute myeloid leukemia and myelodysplastic syndrome.</description><subject>Acute myeloid leukemia</subject><subject>acute myeloid leukemia (AML)</subject><subject>Aged</subject><subject>Antilymphocyte serum</subject><subject>Busulfan</subject><subject>Busulfan - administration & dosage</subject><subject>Conditioning</subject><subject>Cytogenetics</subject><subject>Dosage</subject><subject>Fludarabine</subject><subject>fractionated</subject><subject>Fractionation</subject><subject>Globulins</subject><subject>Humans</subject><subject>Intravenous administration</subject><subject>Leukemia</subject><subject>Leukemia, Myeloid, Acute - drug therapy</subject><subject>Leukemia, Myeloid, Acute - mortality</subject><subject>Methotrexate</subject><subject>myeloablative</subject><subject>Myeloablative Agonists - administration & dosage</subject><subject>Myelodysplastic syndrome</subject><subject>myelodysplastic syndrome (MDS)</subject><subject>Myelodysplastic Syndromes - drug therapy</subject><subject>Myelodysplastic Syndromes - mortality</subject><subject>Myeloid leukemia</subject><subject>Oncology</subject><subject>Prophylaxis</subject><subject>Remission</subject><subject>Survival</subject><subject>Survival Analysis</subject><subject>Tacrolimus</subject><subject>Thymocytes</subject><subject>Transplantation Conditioning</subject><subject>Treatment Outcome</subject><issn>0008-543X</issn><issn>1097-0142</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kc-KFDEQh4Mo7rh68QEk4EWEXvOvO52jDLsqLAqi4K1JJ9WaNZ2MSWeWfgjf2Yy9evDgqajiq48qfgg9peSCEsJemWDSBee85_fQjhIlG0IFu492hJC-aQX_coYe5XxTW8la_hCdcS4kVYLv0M-rpM3iYtALWDyWXPykA55X8FGPXi_uCNjEYN0JcuErdvMhxSNknEs6uqP22AUcvYWEDxWHsGR865ZvWJuywGZyFnso32F2Gutgt6Fd88HrvDiD8xpsijM8Rg8m7TM8uavn6PPV5af92-b6w5t3-9fXjeGK86al09hLaTo2tYbJcVScya7tVKs0sdDZvrWCCm2YkJwaLoUlnZK9qDscVM_P0YvNW1_5USAvw-yyAe91gFjyUPeUJNVKK_r8H_QmlhTqdQNrqeKSCUUq9XKjTIo5J5iGQ3KzTutAyXAKaTiFNPwOqcLP7pRlnMH-Rf-kUgG6AbfOw_of1bB_v_-4SX8Bw-KfVQ</recordid><startdate>20210515</startdate><enddate>20210515</enddate><creator>Oran, Betül</creator><creator>Saliba, Rima M.</creator><creator>Mehta, Rohtesh S.</creator><creator>Alousi, Amin M.</creator><creator>Marin, David</creator><creator>Valdez, Ben C.</creator><creator>Chen, Julianne</creator><creator>Bashir, Qaiser</creator><creator>Ciurea, Stefan O.</creator><creator>Olson, Amanda L.</creator><creator>Hosing, Chitra</creator><creator>Kebriaei, Partow</creator><creator>Rezvani, Katy</creator><creator>Shpall, Elizabeth J.</creator><creator>Champlin, Richard E.</creator><creator>Andersson, Borje S.</creator><creator>Popat, Uday R.</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TO</scope><scope>7U7</scope><scope>C1K</scope><scope>H94</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-7592-2224</orcidid><orcidid>https://orcid.org/0000-0002-8532-544X</orcidid><orcidid>https://orcid.org/0000-0003-1264-5968</orcidid><orcidid>https://orcid.org/0000-0001-8597-3271</orcidid></search><sort><creationdate>20210515</creationdate><title>Fractionated busulfan myeloablative conditioning improves survival in older patients with acute myeloid leukemia and myelodysplastic syndrome</title><author>Oran, Betül ; Saliba, Rima M. ; Mehta, Rohtesh S. ; Alousi, Amin M. ; Marin, David ; Valdez, Ben C. ; Chen, Julianne ; Bashir, Qaiser ; Ciurea, Stefan O. ; Olson, Amanda L. ; Hosing, Chitra ; Kebriaei, Partow ; Rezvani, Katy ; Shpall, Elizabeth J. ; Champlin, Richard E. ; Andersson, Borje S. ; Popat, Uday R.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3933-51fb877c62f5c27bb9327656959a0de6d85d414ac24731c374d06978477c3e983</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Acute myeloid leukemia</topic><topic>acute myeloid leukemia (AML)</topic><topic>Aged</topic><topic>Antilymphocyte serum</topic><topic>Busulfan</topic><topic>Busulfan - administration & dosage</topic><topic>Conditioning</topic><topic>Cytogenetics</topic><topic>Dosage</topic><topic>Fludarabine</topic><topic>fractionated</topic><topic>Fractionation</topic><topic>Globulins</topic><topic>Humans</topic><topic>Intravenous administration</topic><topic>Leukemia</topic><topic>Leukemia, Myeloid, Acute - drug therapy</topic><topic>Leukemia, Myeloid, Acute - mortality</topic><topic>Methotrexate</topic><topic>myeloablative</topic><topic>Myeloablative Agonists - administration & dosage</topic><topic>Myelodysplastic syndrome</topic><topic>myelodysplastic syndrome (MDS)</topic><topic>Myelodysplastic Syndromes - drug therapy</topic><topic>Myelodysplastic Syndromes - mortality</topic><topic>Myeloid leukemia</topic><topic>Oncology</topic><topic>Prophylaxis</topic><topic>Remission</topic><topic>Survival</topic><topic>Survival Analysis</topic><topic>Tacrolimus</topic><topic>Thymocytes</topic><topic>Transplantation Conditioning</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Oran, Betül</creatorcontrib><creatorcontrib>Saliba, Rima M.</creatorcontrib><creatorcontrib>Mehta, Rohtesh S.</creatorcontrib><creatorcontrib>Alousi, Amin M.</creatorcontrib><creatorcontrib>Marin, David</creatorcontrib><creatorcontrib>Valdez, Ben C.</creatorcontrib><creatorcontrib>Chen, Julianne</creatorcontrib><creatorcontrib>Bashir, Qaiser</creatorcontrib><creatorcontrib>Ciurea, Stefan O.</creatorcontrib><creatorcontrib>Olson, Amanda L.</creatorcontrib><creatorcontrib>Hosing, Chitra</creatorcontrib><creatorcontrib>Kebriaei, Partow</creatorcontrib><creatorcontrib>Rezvani, Katy</creatorcontrib><creatorcontrib>Shpall, Elizabeth J.</creatorcontrib><creatorcontrib>Champlin, Richard E.</creatorcontrib><creatorcontrib>Andersson, Borje S.</creatorcontrib><creatorcontrib>Popat, Uday R.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>Toxicology Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Cancer</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Oran, Betül</au><au>Saliba, Rima M.</au><au>Mehta, Rohtesh S.</au><au>Alousi, Amin M.</au><au>Marin, David</au><au>Valdez, Ben C.</au><au>Chen, Julianne</au><au>Bashir, Qaiser</au><au>Ciurea, Stefan O.</au><au>Olson, Amanda L.</au><au>Hosing, Chitra</au><au>Kebriaei, Partow</au><au>Rezvani, Katy</au><au>Shpall, Elizabeth J.</au><au>Champlin, Richard E.</au><au>Andersson, Borje S.</au><au>Popat, Uday R.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Fractionated busulfan myeloablative conditioning improves survival in older patients with acute myeloid leukemia and myelodysplastic syndrome</atitle><jtitle>Cancer</jtitle><addtitle>Cancer</addtitle><date>2021-05-15</date><risdate>2021</risdate><volume>127</volume><issue>10</issue><spage>1598</spage><epage>1605</epage><pages>1598-1605</pages><issn>0008-543X</issn><eissn>1097-0142</eissn><abstract>Background
A myeloablative conditioning regimen can be safely given to older patients and those with comorbidities without increasing nonrelapse mortality (NRM) by fractionating the dose of intravenous busulfan. How this approach compares in efficacy with traditional, nonfractionated, lower dose regimens is unknown.
Methods
Outcomes were compared in patients with acute myeloid leukemia (AML) or myelodysplastic syndrome who received either myeloablative, fractionated busulfan (f‐Bu) dosed to achieve an area under the curve of 20,000 μmol per minute (f‐Bu20K) over 2 weeks (n = 84) or a standard, nonfractionated, lower busulfan dose regimen of 16,000 μmol per minute (Bu16K) over 4 days (n = 78). Both groups also received fludarabine 40 mg/m2 intravenously for 4 days. Graft‐versus‐host disease prophylaxis was tacrolimus and methotrexate. Patients in the Bu16K group who had unrelated donors also received antithymocyte globulin. The primary endpoint was progression‐free survival.
Results
Roughly one‐half of the patients were aged >65 years, approximately 40% had poor‐risk cytogenetics, approximately 40% of those with AML were not in complete remission, and approximately 40% had a comorbidity index >3. At 2 years, progression‐free survival was significantly improved in the f‐Bu20K group compared with the Bu16K group (45% vs 24%, respectively; hazard ratio [HR], 0.6; 95% CI, 0.4‐0.8; P = .004). This was because of a significant reduction in progression (34% vs 59%, respectively; HR, 0.5; 95% CI, 0.3‐0.8; P = .003) without any increase in NRM (21% vs 15%, respectively; HR, 1.4; 95% CI, 0.7‐3; P = .3), which resulted in improved overall survival (51% vs 31%, respectively; HR, 0.6; 95% CI, 0.3‐0.9; P = .01).
Conclusions
A myeloablative, fractionated busulfan regimen reduces relapse and improves survival without increasing NRM in older patients with AML and myelodysplastic syndrome.
A myeloablative, fractionated regimen of busulfan reduces relapse and improves survival without increasing nonrelapse mortality in older patients with acute myeloid leukemia and myelodysplastic syndrome.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>33471943</pmid><doi>10.1002/cncr.33383</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-7592-2224</orcidid><orcidid>https://orcid.org/0000-0002-8532-544X</orcidid><orcidid>https://orcid.org/0000-0003-1264-5968</orcidid><orcidid>https://orcid.org/0000-0001-8597-3271</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0008-543X |
| ispartof | Cancer, 2021-05, Vol.127 (10), p.1598-1605 |
| issn | 0008-543X 1097-0142 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2479709321 |
| source | MEDLINE; Access via Wiley Online Library; EZB-FREE-00999 freely available EZB journals; Wiley Online Library (Open Access Collection); Alma/SFX Local Collection |
| subjects | Acute myeloid leukemia acute myeloid leukemia (AML) Aged Antilymphocyte serum Busulfan Busulfan - administration & dosage Conditioning Cytogenetics Dosage Fludarabine fractionated Fractionation Globulins Humans Intravenous administration Leukemia Leukemia, Myeloid, Acute - drug therapy Leukemia, Myeloid, Acute - mortality Methotrexate myeloablative Myeloablative Agonists - administration & dosage Myelodysplastic syndrome myelodysplastic syndrome (MDS) Myelodysplastic Syndromes - drug therapy Myelodysplastic Syndromes - mortality Myeloid leukemia Oncology Prophylaxis Remission Survival Survival Analysis Tacrolimus Thymocytes Transplantation Conditioning Treatment Outcome |
| title | Fractionated busulfan myeloablative conditioning improves survival in older patients with acute myeloid leukemia and myelodysplastic syndrome |
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