Abstract
The impact of conditioning regimen prior to hematopoietic cell transplant (HCT) in pediatric AML-patients is not well studied. We retrospectively analyzed the impact of Busulfan–Cyclophosphamide (BuCy), Busulfan–Cyclophosphamide–Melphalan (BuCyMel) and Clofarabine–Fludarabine–Busulfan (CloFluBu) in pediatric AML-patients, with similar upfront leukemia treatment (NOPHO-DBHconsortium), receiving an HCT between 2010 and 2015. Outcomes of interest were LFS, relapse, TRM and GvHD. 103 patients were included; 30 received BuCy, 37 BuCyMel, and 36 CloFluBu. The 5-years LFS was 43.3% (SE ± 9.0) in the BuCy group, 59.2 % (SE ± 8.1) after BuCyMel, and 66.7 % (SE ± 7.9) after CloFluBu. Multivariable Cox regression analysis showed a trend to lower LFS after BuCy compared to CloFluBu (p = 0.07). BuCy was associated with a higher relapse incidence compared to the other regimens (p = 0.06). Younger age was a predictor for relapse (p = 0.02). A strong correlation between Busulfan Therapeutic Drug Monitoring (TDM) and lower incidence of aGvHD (p < 0.001) was found. In conclusion, LFS after BuCyMel and CloFluBu was comparable, lower LFS was found after BuCy, due to higher relapse incidence. CloFluBu was associated with lower incidence of aGvHD, suggesting lower toxicity with this type of conditioning. This finding is also explained by the impact of Busulfan monitoring.
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Change history
15 March 2021
A Correction to this paper has been published: https://doi.org/10.1038/s41409-021-01257-2
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Acknowledgements
We would like to thank Statistikertjänst at Gothenburg University for excellent statistical analysis. We also want to thank doctors, nurses, and patients in the different centers for contributing to the study. The study was sponsored by Swedish Childhood Cancer Foundation and The Västra Götaland County Council (ALF project).
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Versluys, A.B., Boelens, J.J., Pronk, C. et al. Hematopoietic cell transplant in pediatric acute myeloid leukemia after similar upfront therapy; a comparison of conditioning regimens. Bone Marrow Transplant 56, 1426–1432 (2021). https://doi.org/10.1038/s41409-020-01201-w
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DOI: https://doi.org/10.1038/s41409-020-01201-w