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Conditioning

Comparing i.v. BU dose intensity between two regimens (FB2 vs FB4) for allogeneic HCT for AML in CR1: a report from the Acute Leukemia Working Party of EBMT

Abstract

This retrospective analysis compared two regimens of fludarabine combined with i.v. BU 6.4 mg/kg (FB2) or BU 12.8 mg/kg (FB4) for allografting of AML in first CR. A total of 437 patients (median age: 50 years) were administered FB2 (n=225, 51%) or FB4 (n=212, 49%). Median follow-up time was 28 months. Use of FB2 resulted in a longer time to neutrophil engraftment (17 vs 15 days, P<0.0001) but no difference in incidence of grade II–IV acute (P=0.54) or chronic GVHD (P=0.51). In patients <50 years of age, FB2 was associated with a higher 2-year cumulative incidence of relapse (33±6% vs 20±4%, P=0.04), but there was no difference in 2-year leukemia-free survival (LFS) (P=0.45), OS (P=0.53) or non-relapse mortality (P=0.17). In recipients 50 years of age, FB2 resulted in better 2-year LFS (63±4% vs 42±7%, P=0.02) and OS (68±4% vs 45±7%, P=0.006); a lower 2-year non-relapse mortality, albeit not statistically significant (15±3% vs 29±6%, P=0.06), was observed with FB2. FB2 is an effective and well-tolerated regimen in patients 50 years of age and does not compromise survival when used in patients <50 years undergoing allogeneic transplantation for AML in first CR.

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Correspondence to M Mohty.

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DB has received honoraria and research funding from Sanofi and Pierre Fabre; MM has received honoraria from Pierre Fabre and Otsuka and received research funding from Pierre Fabre. The remaining authors declare no conflict of interest.

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Kharfan-Dabaja, M., Labopin, M., Bazarbachi, A. et al. Comparing i.v. BU dose intensity between two regimens (FB2 vs FB4) for allogeneic HCT for AML in CR1: a report from the Acute Leukemia Working Party of EBMT. Bone Marrow Transplant 49, 1170–1175 (2014). https://doi.org/10.1038/bmt.2014.133

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