期刊
BLOOD ADVANCES
卷 4, 期 13, 页码 3180-3190出版社
AMER SOC HEMATOLOGY
DOI: 10.1182/bloodadvances.2019001266
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资金
- National Institutes of Health, National Cancer Institute (NCI)
- National Heart, Lung, and Blood Institute (NHLBI)
- National Institute of Allergy and Infectious Diseases (NIAID) [U24CA076518]
- NHLBI
- NCI [5P01CA111412, R01CA152108, 1R01CA231141, U24HL138660]
- Health Resources and Services Administration [HHSH250201700006C]
- Office of Naval Research [N0001418-1-2888, N00014-17-1-2850]
- HRSA subaward [SC1MC31881-01-00]
- NHLBI [R01HL131731, R01HL126589, 5R01HL129472, 1R01HL131731, OT3HL147741, R21HL140314, U01HL128568]
- National Institute of Allergy and Infectious Diseases [1U01AI126612]
- Actinium Pharmaceuticals Inc.
- Adaptive Biotechnologies
- Allovir Inc.
- Amgen Inc.
- Anthem Inc.
- HistoGenetics Inc.
- Astellas Pharma US
- Atara Biotherapeutics Inc.
- BARDA
- Be the Match Foundation
- bluebird bio Inc.
- Boston Children's Hospital
- Bristol Myers Squibb Co.
- Celgene Corp.
- Children's Hospital of Los Angeles
- Chimerix Inc.
- City of Hope Medical Center
- CSL Behring
- CytoSen Therapeutics Inc.
- Daiichi Sankyo Co. Ltd.
- Dana Farber Cancer Institute
- Enterprise Science and Computing Inc.
- Fred Hutchinson Cancer Research Center
- Gamida-Cell Ltd.
- Genzyme
- Gilead Sciences Inc.
- GlaxoSmithKline
- Immucor
- Incyte Corporation
- Janssen Biotech Inc.
- Janssen Pharmaceuticals Inc.
- Janssen Research & Development LLC
- Janssen Scientific Affairs LLC
- Japan Hematopoietic Cell Transplantation Data Center
- Jazz Pharmaceuticals Inc.
- Karius Inc.
- Karyopharm Therapeutics Inc.
- Kite (a Gilead Company)
- Kyowa Kirin
- Magenta Therapeutics
- Mayo Clinic
- Foundation Rochester
- Medac GmbH
- Mediware
- Memorial Sloan-Kettering Cancer Center
- Merck Company Inc.
- Mesoblast
- MesoScale Diagnostics Inc.
- Millennium
- Takeda Oncology Co.
- Miltenyi Biotec Inc.
- Mundipharma EDO
- National Marrow Donor Program
- Novartis Oncology
- Novartis Pharmaceuticals Corporation
- Omeros Corporation
- Oncoimmune Inc.
- OptumHealth
- Orca Biosystems Inc.
- PCORI
- Pfizer Inc.
- Phamacyclics LLC
- PIRCHE AG
- Regeneron Pharmaceuticals Inc.
- REGiMMUNE Corp.
- Sanofi Genzyme
- Seattle Genetics
- Shire
- Sobi Inc.
- Spectrum Pharmaceuticals Inc.
- St. Baldrick's Foundation
- Swedish Orphan Biovitrum Inc.
- Takeda Oncology
- Medical College of Wisconsin
- University of Minnesota
- University of Pittsburgh
- University of Texas-MD Anderson
- University of Wisconsin-Madison
- Viracor Eurofins
- Xenikos BV
- NATIONAL CANCER INSTITUTE [ZIACP010190] Funding Source: NIH RePORTER
There is a lack of large comparative study on the outcomes of reduced intensity conditioning (RIC) in acute myeloid leukemia (AML) transplantation using fludarabine/busulfan (FB) and fludarabine/melphalan (FM) regimens. Adult AML patients from Center for International Blood and Marrow Transplant Research who received first RIC allo-transplant between 2001 and 2015 were studied. Patients were excluded if they received cord blood or identical twin transplant, total body irradiation in conditioning, or graft-versus-host disease (GVHD) prophylaxis with in vitro T-cell depletion. Primary outcome was overall survival (OS), secondary end points were leukemia-free survival (LFS), nonrelapse mortality (NRM), relapse, and GVHD. Multivariate survival model was used with adjustment for patient, leukemia, and transplant-related factors. A total of 622 patients received FM and 791 received FB RIC. Compared with FB, the FM group had fewer transplant in complete remission (CR), fewer matched sibling donors, and less usage of anti-thymocyte globulin or alemtuzumab. More patients in the FM group received marrow grafts and had transplantation before 2005. OS was significantly lower within the first 3 months posttransplant in the FM group (hazard ratio [HR] = 1.82, P < .001), but was marginally superior beyond 3 months (HR = 0.87, P = .05). LFS was better with FM compared with FB (HR = 0.89, P = .05). NRM was significantly increased in the FM group during the first 3 months of posttransplant (HR = 3.85, P < .001). Long-term relapse was lower with FM (HR = 0.65, P < .001). Analysis restricted to patients with CR showed comparable results. In conclusion, compared with FB, the FM RIC showed a marginally superior long-term OS and LFS and a lower relapse rate. A lower OS early posttransplant within 3 months was largely the result of a higher early NRM.
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