Thiotepa, busulfan and fludarabine compared to busulfan and cyclophosphamide as conditioning regimen for allogeneic stem cell transplant from matched siblings and unrelated donors for acute myeloid leukemia. - Université de Lille Accéder directement au contenu
Article Dans Une Revue American Journal of Hematology Année : 2018

Thiotepa, busulfan and fludarabine compared to busulfan and cyclophosphamide as conditioning regimen for allogeneic stem cell transplant from matched siblings and unrelated donors for acute myeloid leukemia.

Francesco Saraceni
  • Fonction : Auteur
Eric Beohou
  • Fonction : Auteur
Myriam Labopin
  • Fonction : Auteur
William Arcese
  • Fonction : Auteur
Francesca Bonifazi
  • Fonction : Auteur
Polina Stepensky
  • Fonction : Auteur
Mahmoud Aljurf
  • Fonction : Auteur
Benedetto Bruno
  • Fonction : Auteur
Pietro Pioltelli
  • Fonction : Auteur
Jakob Passweg
  • Fonction : Auteur
Gerard Socie
  • Fonction : Auteur
Stella Santarone
  • Fonction : Auteur
Francesco Lanza
  • Fonction : Auteur
N Savani Bipin
  • Fonction : Auteur
Mohamad Mohty
  • Fonction : Auteur
Arnon Nagler
  • Fonction : Auteur

Résumé

Busulfan plus cyclophosphamide (BuCy) is the traditional conditioning regimen for allogeneic stem cell transplant (allo-SCT) for young, fit patients with acute myeloid leukemia (AML). The thiotepa-busulfan-fludarabine (TBF) protocol has recently demonstrated promising outcome in cord blood and haploidentical SCT; however, there is limited evidence about this regimen in transplant from matched siblings (MSD) and unrelated donors (UD). We retrospectively compared outcomes of 2523 patients aged 18-50 with AML in remission, undergoing transplant from MSD or UD prepared with either TBF or BuCy conditioning. A 1:3 pair-matched analysis was performed: 146 patients receiving TBF were compared with 438 patients receiving BuCy. Relapse risk was significantly lower in the TBF when compared with BuCy group (HR 0.6, P = .02), while NRM did not differ. No significant difference was observed in LFS and OS between the two regimens. TBF was associated with a trend towards higher risk of grades III-IV aGVHD (HR 1.8, P = .06) and inferior cGVHD (HR 0.7, P = .04) when compared with BuCy. In patients undergoing transplant in first remission, the advantage for TBF in terms of relapse was more evident (HR 0.4, P = .02), leading to a trend for better LFS in favor of TBF (HR 0.7, P = .10), while OS did not differ between the two cohorts. In conclusion, TBF represents a valid myeloablative conditioning regimen providing significantly lower relapse and similar survival when compared with BuCy. Patients in first remission appear to gain the most from this protocol, as in this subgroup a tendency for better LFS was observed when compared with BuCy.

Dates et versions

hal-04313415 , version 1 (29-11-2023)

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Citer

Francesco Saraceni, Eric Beohou, Myriam Labopin, William Arcese, Francesca Bonifazi, et al.. Thiotepa, busulfan and fludarabine compared to busulfan and cyclophosphamide as conditioning regimen for allogeneic stem cell transplant from matched siblings and unrelated donors for acute myeloid leukemia.. American Journal of Hematology, 2018, American Journal of Hematology, 93, pp.1211-1219. ⟨10.1002/ajh.25225⟩. ⟨hal-04313415⟩

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