Journal
BIOLOGY OF BLOOD AND MARROW TRANSPLANTATION
Volume 23, Issue 3, Pages 445-451Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.bbmt.2016.11.023
Keywords
Allogeneic hematopoietic stem cell transplantation; Myeloid malignancies; Reduced-toxicity conditioning; Reduced-intensity conditioning
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Treosulfan has been incorporated in conditioning regimens for sustained remission without substantial toxicity and treatment-related mortality (TRM). We aimed to analyze the safety and efficacy of a fludarabine 150 mg/m(2) and treosulfan 42 g/m(2) (FluTreo) conditioning regimen in medically infirm patients. Outcomes were compared with those of a similar historical group treated with fludarabine 150 mg/m(2) to 180 mg/m2, busulfan 6.4 mg/kg, and antithymocyte globulin (ATG) 5 mg/kg to 7.5 mg/kg (FIuBuATG). Thirty-one consecutive patients with acute myeloid leukemia (AML; n = 21), myelodysplastic syndrome (MDS; n = 6), or treatment-related AML (n = 4) received FluTreo conditioning. The historical group consisted of 26 consecutive patients treated with F1uBuATG. In the FluTreo group, engraftment was prompt in all patients and 74% achieved >99% donor chimerism by day +30. No grades III or IV organ toxicities were noted. One-year cumulative incidences (CI) of acute and chronic graft-versus-host disease (GVHD) were 19.4% and 58.4%. The groups were similar for age, disease risk, lines of treatment, hematopoietic cell transplantation-specific comorbidity index, and acute or chronic GVHD incidence, except that there were more matched unrelated donor recipients in the FluTreo group (P <.001). With 20 (range, 2 to 36) months follow-up for FluTreo and 14 (range, 2 to 136) for FIuBuATG, the 1-year cumulative overall survival (OS) probability was 76% versus 57%, respectively (P =.026); 1-year disease free survival (DFS) was 79% versus 38% (P <.001). In multivariate analysis, the only significantly favorable factor for OS and DFS was FluTreo (P =.010 and P =.012). The CI of relapse mortality was markedly decreased in FluTreo versus FIuBuATG (7.4% versus 42.3%, P <.001). In conclusion, the treosulfan-based regimen resulted in favorable OS and DFS with acceptable toxicity and low relapse rates compared with busulfan-based conditioning. (C) 2017 American Society for Blood and Marrow Transplantation.
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