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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Fludarabine and Melphalan Compared with Reduced Doses of Busulfan and Fludarabine Improve Transplantation Outcomes in Older Patients with Myelodysplastic Syndromes
Transplantation and Cellular Therapy, Volume 27, No. 11, Year 2021
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Description
Reduced-intensity conditioning (RIC) regimens developed to extend the use of allogeneic hematopoietic stem cell transplantation (HSCT) to older patients have resulted in encouraging outcomes. We aimed to compare the 2 most commonly used RIC regimens, i.v. fludarabine with busulfan (FluBu) and fludarabine with melphalan (FluMel), in patients with myelodysplastic syndrome (MDS). Through the Center for International Blood and Marrow Transplant Research (CIBMTR), we identified 1045 MDS patients age ≥60 years who underwent first HSCT with a matched related or matched (8/8) unrelated donor using an RIC regimen. The CIBMTR's definition of RIC was used: a regimen that incorporated an i.v. busulfan total dose ≤7.2 mg/kg or a low-dose melphalan total dose ≤150 mg/m2. The 2 groups, recipients of FluBu (n = 697) and recipients of FluMel (n = 448), were comparable in terms of disease- and transplantation-related characteristics except for the more frequent use of antithymocyte globulin or alemtuzumab in the FluBu group (39% versus 31%). The median age was 67 years in both groups. FluMel was associated with a reduced relapse incidence (RI) compared with FluBu, with a 1-year adjusted incidence of 26% versus 44% (P ≤ .0001). Transplantation-related mortality (TRM) was higher in the FluMel group (26% versus 16%; P ≤ .0001). Because the magnitude of improvement with FluMel in RI was greater than the improvement in TRM with FluBu, disease-free survival (DFS) was better at 1 year and beyond with FluMel compared with FluBu (48% versus 40% at 1 year [P = .02] and 35% versus 27% at 3 years [P = .01]). Overall survival was comparable in the 2 groups at 1 year (63% versus 61%; P = .4) but was significantly improved with FluMel compared with FluBu at 3 years (46% versus 39%; P = .03). Our results suggest that FluMel is associated with superior DFS compared with FluBu owing to reduced RI in older patients with MDS patients. © 2021 American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc.
Authors & Co-Authors
Oran, Betül M.
United States, Houston
The University of Texas Md Anderson Cancer Center
Ahn, Kwang Woo
United States, Milwaukee
Medical College of Wisconsin
Fretham, Caitrin
United States, Minneapolis
National Marrow Donor Program
Beitinjaneh, Amer
United States, Coral Gables
University of Miami
Bashey, Asad
United States, Coral Gables
University of Miami
Pawarode, Attaphol
United States, Ann Arbor
University of Michigan Medical School
Wirk, Baldeep
United States, Hershey
Penn State Cancer Institute
Scott, Bart L.
United States, Seattle
Fred Hutchinson Cancer Research Center
Savani, Bipin N.
United States, Nashville
Vanderbilt University Medical Center
Bredeson, Christopher N.
Canada, Ottawa
Ottawa Hospital Research Institute
Weisdorf, Daniel J.
United States, Minneapolis
University of Minnesota Twin Cities
Marks, David Ian
United Kingdom, Bristol
University Hospitals Bristol and Weston Nhs Foundation Trust
Rizzieri, David
United States, Durham
Duke University
Copelan, Edward A.
United States, Charlotte
Levine Cancer Institute
Hildebrandt, Gerhard C.
United States, Lexington
Uk Healthcare
Hale, Gregory A.
United States, St Petersburg
Johns Hopkins all Children's Hospital
Murthy, Hemant S.
United States, Jacksonville
Mayo Clinic in Jacksonville, Florida
Lazarus, Hillard Michael
United States, Cleveland
University Hospitals Case Medical Center
Černý, Jan
United States, Worcester
University of Massachusetts Chan Medical School
Liesveld, Jane L.
United States, Rochester
University of Rochester Medical Center
Yared, Jean A.
United States, Baltimore
University of Maryland, Baltimore Umb
Yves-Cahn, Jean
France, Grenoble
Centre Hospitalier Universitaire de Grenoble
Szer, Jeffrey
Australia, Melbourne
Peter Maccallum Cancer Centre
Verdonck, Leo F.
Netherlands, Zwolle
Isala Clinics
Aljurf, Mahmoud Deeb
Saudi Arabia, Riyadh
King Faisal Specialist Hospital and Research Centre
van Der Poel, Marjolein
Netherlands, Maastricht
Universiteit Maastricht
Litzow, Mark Robert
United States, Rochester
Mayo Clinic
Kalaycio, Matt
United States, Cleveland
Cleveland Clinic Foundation
Grunwald, Michael R.
United States, Charlotte
Levine Cancer Institute
Díaz, Miguel Angel Ruiz
Spain, Madrid
Hospital Infantil Universitario Niño Jesús
Sabloff, Mitchell
Canada, Ottawa
L’école de Médecine
Kharfan-Dabaja, M.
United States, Jacksonville
Mayo Clinic in Jacksonville, Florida
Majhail, Navneet Singh
United States, Cleveland
Taussig Cancer Center
Farhadfar, Nosha
United States, Gainesville
University of Florida College of Medicine
Reshef, Ran
United States, New York
Columbia University Irving Medical Center
Olsson, Richard F.
Sweden, Stockholm
Karolinska Institutet
Sweden, Uppsala
Uppsala Universitet
Gale, Robert Peter
United Kingdom, London
Imperial College London
Nakamura, Ryotaro
United States, Duarte
City of Hope National Med Center
Seo, Sachiko
Japan, Shimotsuga District
Dokkyo Medical University
Chhabra, Saurabh
United States, Milwaukee
Medical College of Wisconsin
Hashmi, Shahrukh Khurshid
United States, Rochester
Mayo Clinic
Saudi Arabia, Riyadh
King Faisal Specialist Hospital and Research Centre
Farhan, Shatha
United States, Detroit
Henry Ford Hospital
Ganguly, Siddhartha
United States, Kansas City
University of Kansas Health System
Nathan, Sunita
United States, Chicago
Rush University Medical Center
Nishihori, Taiga
United States, Tampa
Moffitt Cancer Center
Jain, Tania
United States, Baltimore
The Sidney Kimmel Comprehensive Cancer Center
Agrawal, Vaibhav
United States, Indianapolis
Indiana University School of Medicine
Bacher, Ulrike
Switzerland, Bern
University Hospital Bern
Popat, Uday R.
United States, Houston
The University of Texas Md Anderson Cancer Center
Saber, Wael
United States, Milwaukee
Medical College of Wisconsin
Statistics
Citations: 50
Authors: 50
Affiliations: 44
Identifiers
Doi:
10.1016/j.jtct.2021.08.007
ISSN:
26666367
Study Design
Cohort Study