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Comparison of FLAMSA-based reduced intensity conditioning with treosulfan/fludarabine conditioning for patients with acute myeloid leukemia: an ALWP/EBMT analysis

Bone Marrow Transplantation volume 54, pages 531–539 (2019)Cite this article

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Abstract

FLAMSA followed by sequential reduced intensity conditioning and treosulfan/fludarabine are frequently used conditioning approaches used in centers of the European Society for Blood and Marrow Transplantation (EBMT) for older patients with acute myeloid leukemia (AML). It is currently unknown whether any of these regimens is superior to the others in terms of disease control and toxicity. Using the Acute Leukemia Working Party/EBMT multicenter registry we compared the outcomes of AML patients 45–65 of age transplanted between the years 2007 and 2016. A total of 629 patients were included in the analysis: 281 in the Treo/Flu group, 203 in the FLAMSA/TBI group, and 145 in the FLAMSA/Busulfan group. In multivariate analysis, FLAMSA/TBI conditioned patients had a decreased risk of relapse (hazard ratio (HR) = 0.43; 95% confidence interval (CI), 0.25–0.75; p = 0.002) and superior leukemia-free survival (HR = 0.67; 95% CI, 0.45–0.98; p = 0.042) compared to Treo/Flu conditioned patients. Rates of acute graft-versus-host disease (GVHD) were significantly higher in the FLAMSA/TBI group compared to the Treo/Flu group (HR = 2.004; 95% CI, 1.09–3.67; p = 0.024). Overall survival, non-relapse mortality, and chronic GVHD were not significantly impacted by the specific regimen used. The choice of either FLAMSA/TBI, FLAMSA/Bu, or Treo/Flu results in no major impact on survival of older AML patients.

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Acknowledgements

We thank the data managers of the EBMT/ALWP and participating EBMT centers.

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Authors and Affiliations

  1. Department of Hematology and Stem Cell Transplant, Kings College Hospital, London, London, UK

    Vipul Sheth

  2. EBMT Paris Office, CEREST-TC, Department of Hematology, Saint Antoine Hospital, Paris, France

    Myriam Labopin, Mohammad Mohty & Arnon Nagler

  3. Hematology Division, Chaim Sheba Medical Center, Tel Hashomer, Tel Aviv University, Tel Aviv, Israel

    Jonathan Canaani, Roni Shouval & Arnon Nagler

  4. Stem Cell Transplantation Unit, HUCH Comprehensive Cancer Center, Helsinki, Finland

    Liisa Volin

  5. Deutsche Klinik fuer diagnostik, KMT Zentrum, Weisbaden, Germany

    Arne Brecht

  6. Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany

    Arnold Ganser

  7. Department of Internal Medicine, Hematooncology, University Hospital Brno, Brno, Czech Republic

    Jiri Mayer

  8. Center Hospitalier Lyon Sud, Pavillon Marcel Bérard -Bat 1G, Service Hematologie, Lyon, France

    Hélène Labussière-Wallet

  9. Department of Internal Medicine, BMT Unit, University of Saarland University Hospital, Homburg, Germany

    Jörg Bittenbring

  10. Department of Hematology and Stem Cell Transplant, Vanderbilt University, Nashville, TN, USA

    Bipin Savani

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  1. Vipul Sheth
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Correspondence to Arnon Nagler.

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Sheth, V., Labopin, M., Canaani, J. et al. Comparison of FLAMSA-based reduced intensity conditioning with treosulfan/fludarabine conditioning for patients with acute myeloid leukemia: an ALWP/EBMT analysis. Bone Marrow Transplant 54, 531–539 (2019). https://doi.org/10.1038/s41409-018-0288-0

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