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Hematopoietic cell transplant in pediatric acute myeloid leukemia after similar upfront therapy; a comparison of conditioning regimens

Bone Marrow Transplantation volume 56, pages 1426–1432 (2021)Cite this article

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A Correction to this article was published on 15 March 2021

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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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Fig. 1: LFS according to conditioning.
Fig. 2: Relapse according to conditioning.
Fig. 3: TRM according to conditioning.
Fig. 4: aGVHD according to conditioning.

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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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Authors and Affiliations

  1. Department of Pediatric Blood and Marrow Transplantation, Princess Máxima Center for Pediatric Oncology, University Medical Center Utrecht, Utrecht, The Netherlands

    A. B. Versluys & J. J. Boelens

  2. Department of Pediatrics, Stem Cell Transplantation and Cellular Therapy, Memorial Sloan Kettering, New York, NY, USA

    J. J. Boelens

  3. Department of Pediatric Oncology and Hematology, Skane University Hospital, Lund, Sweden

    C. Pronk

  4. Department of Pediatrics, Willem Alexander Children’s Hospital, Leiden University Medical Center, Leiden, The Netherlands

    A. Lankester

  5. Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, Ghent University Hospital, Ghent, Belgium

    V. Bordon

  6. Department of Pediatric Hematology and Oncology, Oslo University Hospital, Oslo, Norway

    J. Buechner

  7. Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark

    M. Ifversen

  8. Department of Women’s and Children’s Health, University Children’s Hospital, Uppsala, Sweden

    N. Jackmann

  9. Pediatric Hematology, Immunology and HCT, Astrid Lindgren Children’s Hospital, Karolinska University Hospital; and Division of Pediatrics, CLINTEC, Karolinska Institutet, Stockholm, Sweden

    M. Sundin

  10. University of Helsinki and Children´s Hospital, University of Helsinki, Helsinki, Finland

    K. Vettenranta

  11. Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden

    J. Abrahamsson & K. Mellgren

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  1. A. B. Versluys
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Correspondence to A. B. Versluys.

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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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