Adding melphalan to fludarabine and a myeloablative dose of busulfan improved survival after allogeneic hematopoietic stem cell transplantation in a propensity score-matched cohort of hematological malignancies
Fludarabine and a myeloablative dose of busulfan (Flu/Bu4) can improve prognosis after allogeneic hematopoietic stem cell transplantation (HSCT) with melphalan (Mel). We investigated the prognostic impact of adding Mel to Flu/Bu4 by comparing between Flu/Bu4/Mel and Flu/Bu4 groups. This study includ...
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| Veröffentlicht in: | Bone marrow transplantation (Basingstoke) 2021-07, Vol.56 (7), p.1691-1699 |
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| creator | Shimomura, Yoshimitsu Hara, Masahiko Yamamoto, Hisashi Uchida, Naoyuki Kawakita, Toshiro Ashida, Takashi Takada, Satoru Ikeda, Takashi Morishige, Satoshi Maruyama, Yumiko Wake, Atsushi Ichinohe, Tatsuo Fukuda, Takahiro Takanashi, Minoko Atsuta, Yoshiko Ishikawa, Takayuki |
| description | Fludarabine and a myeloablative dose of busulfan (Flu/Bu4) can improve prognosis after allogeneic hematopoietic stem cell transplantation (HSCT) with melphalan (Mel). We investigated the prognostic impact of adding Mel to Flu/Bu4 by comparing between Flu/Bu4/Mel and Flu/Bu4 groups. This study included 846 propensity score (PS)-matched patients who received either Flu/Bu4/Mel (
n
= 423) or Flu/Bu4 (
n
= 423) from 2394 patients enrolled in a multicenter prospective registry, from January 2010 to December 2016. The primary endpoint (5-year overall survival [OS]), and the prognostic impact of adding Mel was evaluated using Cox regression analysis. The study population median age was 58 (interquartile 50–64) years and 61.0% were male. Patient characteristics were well-balanced between groups. Five-year OS was 34.2% (95% confidence interval [CI]: 27.3–41.1%) and 30.1% (24.8–35.6%) in the Flu/Bu4/Mel and Flu/Bu4 groups, respectively (log-rank
P
= 0.019). The adjusted hazard ratio of adding Mel was 0.77 (95% CI: 0.62–0.96) (
P
= 0.022) for the 5-year OS, and this attributed to a lower incidence of 5-year relapse (0.71, 0.56–0.90,
P
= 0.005) and relapse associated mortality (0.73, 0.57–0.95,
P
= 0.018). There was no statistical difference in 5-year non-relapse mortality between groups (log-rank
P
= 0.855). Flu/Bu4/Mel was associated with better 5-year OS compared to Flu/Bu4 in a PS-matched cohort after allogeneic HSCT. |
| doi_str_mv | 10.1038/s41409-021-01217-w |
| format | Article |
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n
= 423) or Flu/Bu4 (
n
= 423) from 2394 patients enrolled in a multicenter prospective registry, from January 2010 to December 2016. The primary endpoint (5-year overall survival [OS]), and the prognostic impact of adding Mel was evaluated using Cox regression analysis. The study population median age was 58 (interquartile 50–64) years and 61.0% were male. Patient characteristics were well-balanced between groups. Five-year OS was 34.2% (95% confidence interval [CI]: 27.3–41.1%) and 30.1% (24.8–35.6%) in the Flu/Bu4/Mel and Flu/Bu4 groups, respectively (log-rank
P
= 0.019). The adjusted hazard ratio of adding Mel was 0.77 (95% CI: 0.62–0.96) (
P
= 0.022) for the 5-year OS, and this attributed to a lower incidence of 5-year relapse (0.71, 0.56–0.90,
P
= 0.005) and relapse associated mortality (0.73, 0.57–0.95,
P
= 0.018). There was no statistical difference in 5-year non-relapse mortality between groups (log-rank
P
= 0.855). Flu/Bu4/Mel was associated with better 5-year OS compared to Flu/Bu4 in a PS-matched cohort after allogeneic HSCT.</description><identifier>ISSN: 0268-3369</identifier><identifier>EISSN: 1476-5365</identifier><identifier>DOI: 10.1038/s41409-021-01217-w</identifier><identifier>PMID: 33658646</identifier><language>eng</language><publisher>London: Nature Publishing Group UK</publisher><subject>692/308/174 ; 692/699/1541/1990 ; Busulfan ; Care and treatment ; Cell Biology ; Confidence intervals ; Dosage and administration ; Fludarabine ; Hematology ; Hematopoietic stem cells ; Internal Medicine ; Leukemia ; Lymphomas ; Medical prognosis ; Medicine ; Medicine & Public Health ; Melphalan ; Mortality ; Patient outcomes ; Population studies ; Public Health ; Regression analysis ; Statistical analysis ; Stem cell transplantation ; Stem Cells ; Survival ; Transplantation</subject><ispartof>Bone marrow transplantation (Basingstoke), 2021-07, Vol.56 (7), p.1691-1699</ispartof><rights>The Author(s), under exclusive licence to Springer Nature Limited part of Springer Nature 2021</rights><rights>COPYRIGHT 2021 Nature Publishing Group</rights><rights>The Author(s), under exclusive licence to Springer Nature Limited part of Springer Nature 2021.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c539t-6e881216d3de8acd6b1ebfc204bac5aaa91a92f72248e8d70f3cbbfe8ec1a58c3</citedby><cites>FETCH-LOGICAL-c539t-6e881216d3de8acd6b1ebfc204bac5aaa91a92f72248e8d70f3cbbfe8ec1a58c3</cites><orcidid>0000-0002-0393-4066 ; 0000-0003-1410-0830 ; 0000-0003-4404-2870 ; 0000-0001-5952-5926 ; 0000-0003-3976-5230 ; 0000-0003-1018-9508</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33658646$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Shimomura, Yoshimitsu</creatorcontrib><creatorcontrib>Hara, Masahiko</creatorcontrib><creatorcontrib>Yamamoto, Hisashi</creatorcontrib><creatorcontrib>Uchida, Naoyuki</creatorcontrib><creatorcontrib>Kawakita, Toshiro</creatorcontrib><creatorcontrib>Ashida, Takashi</creatorcontrib><creatorcontrib>Takada, Satoru</creatorcontrib><creatorcontrib>Ikeda, Takashi</creatorcontrib><creatorcontrib>Morishige, Satoshi</creatorcontrib><creatorcontrib>Maruyama, Yumiko</creatorcontrib><creatorcontrib>Wake, Atsushi</creatorcontrib><creatorcontrib>Ichinohe, Tatsuo</creatorcontrib><creatorcontrib>Fukuda, Takahiro</creatorcontrib><creatorcontrib>Takanashi, Minoko</creatorcontrib><creatorcontrib>Atsuta, Yoshiko</creatorcontrib><creatorcontrib>Ishikawa, Takayuki</creatorcontrib><title>Adding melphalan to fludarabine and a myeloablative dose of busulfan improved survival after allogeneic hematopoietic stem cell transplantation in a propensity score-matched cohort of hematological malignancies</title><title>Bone marrow transplantation (Basingstoke)</title><addtitle>Bone Marrow Transplant</addtitle><addtitle>Bone Marrow Transplant</addtitle><description>Fludarabine and a myeloablative dose of busulfan (Flu/Bu4) can improve prognosis after allogeneic hematopoietic stem cell transplantation (HSCT) with melphalan (Mel). We investigated the prognostic impact of adding Mel to Flu/Bu4 by comparing between Flu/Bu4/Mel and Flu/Bu4 groups. This study included 846 propensity score (PS)-matched patients who received either Flu/Bu4/Mel (
n
= 423) or Flu/Bu4 (
n
= 423) from 2394 patients enrolled in a multicenter prospective registry, from January 2010 to December 2016. The primary endpoint (5-year overall survival [OS]), and the prognostic impact of adding Mel was evaluated using Cox regression analysis. The study population median age was 58 (interquartile 50–64) years and 61.0% were male. Patient characteristics were well-balanced between groups. Five-year OS was 34.2% (95% confidence interval [CI]: 27.3–41.1%) and 30.1% (24.8–35.6%) in the Flu/Bu4/Mel and Flu/Bu4 groups, respectively (log-rank
P
= 0.019). The adjusted hazard ratio of adding Mel was 0.77 (95% CI: 0.62–0.96) (
P
= 0.022) for the 5-year OS, and this attributed to a lower incidence of 5-year relapse (0.71, 0.56–0.90,
P
= 0.005) and relapse associated mortality (0.73, 0.57–0.95,
P
= 0.018). There was no statistical difference in 5-year non-relapse mortality between groups (log-rank
P
= 0.855). Flu/Bu4/Mel was associated with better 5-year OS compared to Flu/Bu4 in a PS-matched cohort after allogeneic HSCT.</description><subject>692/308/174</subject><subject>692/699/1541/1990</subject><subject>Busulfan</subject><subject>Care and treatment</subject><subject>Cell Biology</subject><subject>Confidence intervals</subject><subject>Dosage and administration</subject><subject>Fludarabine</subject><subject>Hematology</subject><subject>Hematopoietic stem cells</subject><subject>Internal Medicine</subject><subject>Leukemia</subject><subject>Lymphomas</subject><subject>Medical prognosis</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Melphalan</subject><subject>Mortality</subject><subject>Patient outcomes</subject><subject>Population studies</subject><subject>Public Health</subject><subject>Regression analysis</subject><subject>Statistical analysis</subject><subject>Stem cell transplantation</subject><subject>Stem Cells</subject><subject>Survival</subject><subject>Transplantation</subject><issn>0268-3369</issn><issn>1476-5365</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><recordid>eNp9kt1u1DAQhSMEokvhBbhAlpAQNyl2fpzkclXxJ1XiBq6jiT3ZuHLsYDtb7Wv2iZhlC6UIoVxYsc_5xjM-WfZS8AvBy_ZdrETFu5wXIueiEE1-8yjbiKqReV3K-nG24YVs87KU3Vn2LMZrzkVV8fppdkZ7dSsruclut1obt2Mz2mUCC44lz0a7aggwGIcMnGbA5gNaD4OFZPbItI_I_MiGNa52JI-Zl-D3qFlcw97swTIYEwYG1vodOjSKTThD8os3mOgvJpyZQmtZCuDiQoUTsT2hHJUj2oIumnRgUfmAOXnVRHzlJx_SsfaJR3ijqNwM1uwcOGUwPs-ejGAjvrhbz7NvH95_vfyUX335-Plye5WruuxSLrFtaWpSlxpbUFoOAodRFbwaQNUA0AnoirEpiqrFVjd8LNUwjNiiElC3qjzP3p64dNvvK8bUzyYeewKHfo19UXWNEPQeDUlf_yW99mtwdLu-qKuOd53oxL1qBxZ740ZPw1FHaL-VsmkqIbkk1cU_VPRpnI3yDkdD-w8Mb_4wTAg2TdHb9Tju-FBYnIQq-BgDjv0SzAzh0AveHxPXnxLXU-L6n4nrb8j06q61dZhR_7b8ihgJypMg0pHbYbjv_T_YHz315vs</recordid><startdate>20210701</startdate><enddate>20210701</enddate><creator>Shimomura, Yoshimitsu</creator><creator>Hara, Masahiko</creator><creator>Yamamoto, Hisashi</creator><creator>Uchida, Naoyuki</creator><creator>Kawakita, Toshiro</creator><creator>Ashida, Takashi</creator><creator>Takada, Satoru</creator><creator>Ikeda, Takashi</creator><creator>Morishige, Satoshi</creator><creator>Maruyama, Yumiko</creator><creator>Wake, Atsushi</creator><creator>Ichinohe, Tatsuo</creator><creator>Fukuda, Takahiro</creator><creator>Takanashi, Minoko</creator><creator>Atsuta, Yoshiko</creator><creator>Ishikawa, Takayuki</creator><general>Nature Publishing Group UK</general><general>Nature Publishing 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melphalan to fludarabine and a myeloablative dose of busulfan improved survival after allogeneic hematopoietic stem cell transplantation in a propensity score-matched cohort of hematological malignancies</title><author>Shimomura, Yoshimitsu ; Hara, Masahiko ; Yamamoto, Hisashi ; Uchida, Naoyuki ; Kawakita, Toshiro ; Ashida, Takashi ; Takada, Satoru ; Ikeda, Takashi ; Morishige, Satoshi ; Maruyama, Yumiko ; Wake, Atsushi ; Ichinohe, Tatsuo ; Fukuda, Takahiro ; Takanashi, Minoko ; Atsuta, Yoshiko ; Ishikawa, Takayuki</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c539t-6e881216d3de8acd6b1ebfc204bac5aaa91a92f72248e8d70f3cbbfe8ec1a58c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>692/308/174</topic><topic>692/699/1541/1990</topic><topic>Busulfan</topic><topic>Care and treatment</topic><topic>Cell Biology</topic><topic>Confidence intervals</topic><topic>Dosage and administration</topic><topic>Fludarabine</topic><topic>Hematology</topic><topic>Hematopoietic stem cells</topic><topic>Internal Medicine</topic><topic>Leukemia</topic><topic>Lymphomas</topic><topic>Medical prognosis</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Melphalan</topic><topic>Mortality</topic><topic>Patient outcomes</topic><topic>Population studies</topic><topic>Public Health</topic><topic>Regression analysis</topic><topic>Statistical analysis</topic><topic>Stem cell transplantation</topic><topic>Stem Cells</topic><topic>Survival</topic><topic>Transplantation</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Shimomura, Yoshimitsu</creatorcontrib><creatorcontrib>Hara, Masahiko</creatorcontrib><creatorcontrib>Yamamoto, Hisashi</creatorcontrib><creatorcontrib>Uchida, Naoyuki</creatorcontrib><creatorcontrib>Kawakita, Toshiro</creatorcontrib><creatorcontrib>Ashida, 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(Basingstoke)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Shimomura, Yoshimitsu</au><au>Hara, Masahiko</au><au>Yamamoto, Hisashi</au><au>Uchida, Naoyuki</au><au>Kawakita, Toshiro</au><au>Ashida, Takashi</au><au>Takada, Satoru</au><au>Ikeda, Takashi</au><au>Morishige, Satoshi</au><au>Maruyama, Yumiko</au><au>Wake, Atsushi</au><au>Ichinohe, Tatsuo</au><au>Fukuda, Takahiro</au><au>Takanashi, Minoko</au><au>Atsuta, Yoshiko</au><au>Ishikawa, Takayuki</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Adding melphalan to fludarabine and a myeloablative dose of busulfan improved survival after allogeneic hematopoietic stem cell transplantation in a propensity score-matched cohort of hematological malignancies</atitle><jtitle>Bone marrow transplantation (Basingstoke)</jtitle><stitle>Bone Marrow Transplant</stitle><addtitle>Bone Marrow Transplant</addtitle><date>2021-07-01</date><risdate>2021</risdate><volume>56</volume><issue>7</issue><spage>1691</spage><epage>1699</epage><pages>1691-1699</pages><issn>0268-3369</issn><eissn>1476-5365</eissn><abstract>Fludarabine and a myeloablative dose of busulfan (Flu/Bu4) can improve prognosis after allogeneic hematopoietic stem cell transplantation (HSCT) with melphalan (Mel). We investigated the prognostic impact of adding Mel to Flu/Bu4 by comparing between Flu/Bu4/Mel and Flu/Bu4 groups. This study included 846 propensity score (PS)-matched patients who received either Flu/Bu4/Mel (
n
= 423) or Flu/Bu4 (
n
= 423) from 2394 patients enrolled in a multicenter prospective registry, from January 2010 to December 2016. The primary endpoint (5-year overall survival [OS]), and the prognostic impact of adding Mel was evaluated using Cox regression analysis. The study population median age was 58 (interquartile 50–64) years and 61.0% were male. Patient characteristics were well-balanced between groups. Five-year OS was 34.2% (95% confidence interval [CI]: 27.3–41.1%) and 30.1% (24.8–35.6%) in the Flu/Bu4/Mel and Flu/Bu4 groups, respectively (log-rank
P
= 0.019). The adjusted hazard ratio of adding Mel was 0.77 (95% CI: 0.62–0.96) (
P
= 0.022) for the 5-year OS, and this attributed to a lower incidence of 5-year relapse (0.71, 0.56–0.90,
P
= 0.005) and relapse associated mortality (0.73, 0.57–0.95,
P
= 0.018). There was no statistical difference in 5-year non-relapse mortality between groups (log-rank
P
= 0.855). Flu/Bu4/Mel was associated with better 5-year OS compared to Flu/Bu4 in a PS-matched cohort after allogeneic HSCT.</abstract><cop>London</cop><pub>Nature Publishing Group UK</pub><pmid>33658646</pmid><doi>10.1038/s41409-021-01217-w</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-0393-4066</orcidid><orcidid>https://orcid.org/0000-0003-1410-0830</orcidid><orcidid>https://orcid.org/0000-0003-4404-2870</orcidid><orcidid>https://orcid.org/0000-0001-5952-5926</orcidid><orcidid>https://orcid.org/0000-0003-3976-5230</orcidid><orcidid>https://orcid.org/0000-0003-1018-9508</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0268-3369 |
| ispartof | Bone marrow transplantation (Basingstoke), 2021-07, Vol.56 (7), p.1691-1699 |
| issn | 0268-3369 1476-5365 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2497111477 |
| source | EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection |
| subjects | 692/308/174 692/699/1541/1990 Busulfan Care and treatment Cell Biology Confidence intervals Dosage and administration Fludarabine Hematology Hematopoietic stem cells Internal Medicine Leukemia Lymphomas Medical prognosis Medicine Medicine & Public Health Melphalan Mortality Patient outcomes Population studies Public Health Regression analysis Statistical analysis Stem cell transplantation Stem Cells Survival Transplantation |
| title | Adding melphalan to fludarabine and a myeloablative dose of busulfan improved survival after allogeneic hematopoietic stem cell transplantation in a propensity score-matched cohort of hematological malignancies |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-25T12%3A10%3A33IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_proqu&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Adding%20melphalan%20to%20fludarabine%20and%20a%20myeloablative%20dose%20of%20busulfan%20improved%20survival%20after%20allogeneic%20hematopoietic%20stem%20cell%20transplantation%20in%20a%20propensity%20score-matched%20cohort%20of%20hematological%20malignancies&rft.jtitle=Bone%20marrow%20transplantation%20(Basingstoke)&rft.au=Shimomura,%20Yoshimitsu&rft.date=2021-07-01&rft.volume=56&rft.issue=7&rft.spage=1691&rft.epage=1699&rft.pages=1691-1699&rft.issn=0268-3369&rft.eissn=1476-5365&rft_id=info:doi/10.1038/s41409-021-01217-w&rft_dat=%3Cgale_proqu%3EA667741606%3C/gale_proqu%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2549099191&rft_id=info:pmid/33658646&rft_galeid=A667741606&rfr_iscdi=true |