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A retrospective comparison of BU-fludarabine and BU–CY regimens in elderly patients or in patients with comorbidities who received unmanipulated haploidentical hematopoietic SCT

Bone Marrow Transplantation volume 50, pages 601–603 (2015)Cite this article

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Allogeneic hematopoietic SCT (allo-HSCT) is an effective treatment for haematological malignancies. As only about 30% of patients have a matched sibling donor or matched unrelated donor, transplantation from a related haploidentical donor is an effective option.1 There are several kinds of protocols for haploidential transplantation. In our institution, we have developed a novel haploidentical transplantation protocol that does not require in vitro T-cell depletion. With the modified BU–CY conditioning regimen, patients receiving unmanipulated haploidentical SCT (haplo-HSCT) can achieve favourable outcomes.1

However, our previous reports demonstrate that patients with comorbidities have high TRM and low OS while receiving the conventional BU–CY regimen.2, 3 Much of the observed regimen-related toxicities, such as the cardiac toxicity, veno-occlusive disease and haemorrhagic cystitis, are due to CY.4 Substitution with Fludarabine (Flu) is associated with a low incidence of TRM.5, 6 Our previous reports demonstrate that, in older patients and/or patients with severe comorbidities, a modified BU/Flu regimen is well tolerated and safe for use with HLA-identical sibling transplantation.7, 8

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References

  1. Lu DP, Dong L, Wu T, Huang XJ, Zhang MJ, Han W et al. Conditioning including antithymocyte globulin followed by unmanipulated HLA-mismatched/haploidentical blood and marrow transplantation can achieve comparables outcomes with HLA-identical sibling transplantation. Blood 2006; 107: 3065–3073.

    Article  CAS  Google Scholar 

  2. Mo XD, Xu LP, Liu DH, Zhang XH, Chen H, Chen YH et al. The hematopoietic cell transplantation-specific comorbidity index (HCT-CI) is an outcome predictor for partially matched related donor transplantation. Am J Hematol 2013; 88: 497–502.

    Article  Google Scholar 

  3. Wang HT, Chang YJ, Xu LP, Liu DH, Wang Y, Liu KY et al. EBMT risk score can predict the outcome of leukaemia after unmanipulated haploidentical blood and marrow transplantation. Bone Marrow Transplant 2014; 49: 927–933.

    Article  Google Scholar 

  4. McDonald GB, Slattery JT, Bouvier ME, Ren S, Batchelder AL, Kalhorn TF et al. Cyclophosphamide metabolism, liver toxicity, and mortality following hematopoietic stem cell transplantation. Blood 2003; 101: 2043–2048.

    Article  CAS  Google Scholar 

  5. Bornhauser M, Storer B, Slattery JT, Appelbaum FR, Deeg HJ, Hansen J et al. Conditioning with fludarabine and targeted busulfan for transplantation of allogeneic hematopoietic stem cells. Blood 2003; 102: 820–826.

    Article  Google Scholar 

  6. de Lima M, Couriel D, Thall PF, Wang X, Madden T, Jones R et al. Once-daily intravenous busulfan and fludarabine: clinical and pharmacokinetic results of a myeloablative, reduced-toxicity conditioning regimen for allogeneic stem cell transplantation in AML and MDS. Blood 2004; 104: 857–864.

    Article  CAS  Google Scholar 

  7. Wang FR, Huang XJ, Liu DH, Chen H, Wang Y, Tang FF et al. [The efficacy and safety of modified busulfan/fludarabine conditioning regimen in elderly or drug-intolerable patients with hematologic malignancies]. Zhonghua nei ke za zhi 2013; 52: 1028–1032.

    PubMed  Google Scholar 

  8. Chen H, Lu DP, Huang XJ, Liu KY, Xu LP, Han W et al. [Reduced intensity of BuCy conditioning regimen for transplantation in the treatment of malignant hematologic diseases]. Zhonghua xue ye xue za zhi=Zhonghua xueyexue zazhi 2005; 26: 273–276.

    PubMed  Google Scholar 

  9. Sorror ML, Maris MB, Storb R, Baron F, Sandmaier BM, Maloney DG et al. Hematopoietic cell transplantation (HCT)-specific comorbidity index: a new tool for risk assessment before allogeneic HCT. Blood 2005; 106: 2912–2919.

    Article  CAS  Google Scholar 

  10. Lee JH, Joo YD, Kim H, Ryoo HM, Kim MK, Lee GW et al. Randomized trial of myeloablative conditioning regimens: busulfan plus cyclophosphamide versus busulfan plus fludarabine. J Clin Oncol 2013; 31: 701–709.

    Article  CAS  Google Scholar 

  11. Lee JH, Joo YD, Kim H, Ryoo HM, Kim MK, Lee GW et al. Randomized trial of myeloablative conditioning regimens: busulfan plus cyclophosphamide versus busulfan plus fludarabine. J Clin Oncol 2013; 31: 701–709.

    Article  CAS  Google Scholar 

  12. Liu DH, Xu LP, Zhang XH, Wang Y, Yan CH, Wang JZ et al. Substitution of cyclophosphamide in the modified BuCy regimen with fludarabine is associated with increased incidence of severe pneumonia: a prospective, randomized study. Int J Hematol 2013; 98: 708–715.

    Article  CAS  Google Scholar 

  13. Liu H, Zhai X, Song Z, Sun J, Xiao Y, Nie D et al. Busulfan plus fludarabine as a myeloablative conditioning regimen compared with busulfan plus cyclophosphamide for acute myeloid leukemia in first complete remission undergoing allogeneic hematopoietic stem cell transplantation: a prospective and multicenter study. J Hematol Oncol 2013; 6: 15.

    Article  CAS  Google Scholar 

  14. Russell JA, Tran HT, Quinlan D, Chaudhry A, Duggan P, Brown C et al. Once-daily intravenous busulfan given with fludarabine as conditioning for allogeneic stem cell transplantation: study of pharmacokinetics and early clinical outcomes. Biol Blood Marrow Transplant 2002; 8: 468–476.

    Article  CAS  Google Scholar 

  15. Andersson BS, de Lima M, Thall PF, Wang X, Couriel D, Korbling M et al. Once daily i.v. busulfan and fludarabine (i.v. Bu-Flu) compares favorably with i.v. busulfan and cyclophosphamide (i.v. BuCy2) as pretransplant conditioning therapy in AML/MDS. Biology Blood Marrow Transplant 2008; 14: 672–684.

    Article  CAS  Google Scholar 

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Acknowledgements

This work was supported in part by grants from National Natural Science Foundation of China (Grant No. 30971292), National Clinical Priority Specialty of Ministry of Health of China and National Science and Technology Pillar Program (Grant no. 2008BAI61B01) and Collaborative Innovation Center of Hematology. We thank the editage (www.editage.com) for editing and language revision of this paper.

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Authors and Affiliations

  1. Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Peking University People’s Hospital, Beijing, China,

    Y-q Sun, L-p Xu, X-h Zhang, D-h Liu, H Chen, Y Wang, C-h Yan, J-z Wang, F-r Wang, Y-y Zhang, K-y Liu & X-j Huang

  2. Peking-Tsinghua Center for Life Sciences, Beijing, China

    X-j Huang

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X-jH designed the research and revised the paper. Y-qS, L-pX, X-hZ, D-hL, YW, C-hY, F-rW, J-zW, YJ, Y-yZ and K-yL performed the research. Y-qS analysed the data and wrote the paper.

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Sun, Yq., Xu, Lp., Zhang, Xh. et al. A retrospective comparison of BU-fludarabine and BU–CY regimens in elderly patients or in patients with comorbidities who received unmanipulated haploidentical hematopoietic SCT. Bone Marrow Transplant 50, 601–603 (2015). https://doi.org/10.1038/bmt.2014.303

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