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Total body irradiation plus fludarabine versus busulfan plus fludarabine as a myeloablative conditioning for adults with acute myeloid leukemia treated with allogeneic hematopoietic cell transplantation. A study on behalf of the Acute Leukemia Working Party of the EBMT

Bone Marrow Transplantation volume 58, pages 282–287 (2023)Cite this article

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Abstract

Cyclophosphamide is frequently substituted with fludarabine (Flu) in conditioning regimens before allogeneic hematopoietic cell transplantation (allo-HCT). We aimed to compare retrospectively, total body irradiation (12 Gy) plus Flu (FluTBI12) versus busulfan (Bu) plus Flu (FB4) as a myeloablative conditioning before allo-HCT in patients with acute myeloid leukemia (AML). Out of 3203 patients who met the inclusion criteria, 109 patients treated with FluTBI12 and 213 treated with FB4 were included in a final matched-pair analysis. In both groups, median patient age was 41 years, first or second complete remission (CR1/CR2) proportion was 78%/22%, allo-HCT from an unrelated donor was performed in 78% of patients. The probabilities of leukemia-free survival and overall survival at 2 years in FluTBI12 and FB4 groups were 65% vs. 60% (p = 0.64) and 70% vs. 72% (p = 0.87), respectively. The cumulative incidence of relapse was 19% vs. 29% (p = 0.11), while non-relapse mortality was 16% vs. 11%, respectively (p = 0.13). There were no statistical differences in both acute and chronic graft-versus-host disease (GVHD) incidence. The probability of GVHD-free, relapse-free survival (GRFS) was 49% for both groups. FluTBI12 and FB4 are comparable myeloablative regimens before allo-HCT in AML patients transplanted in CR1 and CR2.

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Fig. 1: Graft versus host disease (GVHD) in FluTBI12 and FB4 group.
Fig. 2: Results of allo-HCT in FluTBI12 and FB4 group.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

We sincerely thank the centers of the EBMT for contributing patient information and data collection.

Author information

Authors and Affiliations

  1. Department of Bone Marrow Transplantation and Onco-Hematology, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland

    Ryszard Swoboda & Sebastian Giebel

  2. Sorbonne Université, INSERM UMR-S 938, CRSA, Service d’Hématologie et Thérapie Cellulaire, AP-HP, Hôpital Saint-Antoine, 75 012, Paris, France

    Myriam Labopin

  3. Deptartment of Hematology and Stem Cell Transplantation, University Hospital, Essen, Germany

    Thomas Schroeder

  4. University Hospital Eppendorf, Bone Marrow Transplantation Centre, Hamburg, Germany

    Nicolaus Kröger

  5. Istanbul Florence Nightingale Hospital, Hematopoietic SCT Unit, Istanbul, Turkey

    Mutlu Arat

  6. Division of Hematology and Oncology, Vanderbilt University Medical Center, Nashville, TN, USA

    Bipin Savani

  7. BMT Unit, University Hospital of Patras, Patras, Greece

    Alexandros Spyridonidis

  8. Centre Pierre et Marie Curie, Service Hématologie Greffe de Moëlle, Alger, Algeria

    Rose-Marie Hamladji

  9. Department of Haematological Medicine, Kings College Hospital, King’s Denmark Hill Campus, London, UK

    Victoria Potter

  10. Hopital Jean Minjoz Service d’Hématologie, Besancon, France

    Ana Berceanu

  11. CHU de Lille, Univ de Lille, INSERM U1286, Infinite, 59000, Lille, France

    Ibrahim Yakoub-Agha

  12. Department of Oncology and Hematology, University of Milan and ASST Papa Giovanni XXIII, Bergamo, Italy

    Alessandro Rambaldi

  13. Haematology Division, BMT Unit, Haematology Research Laboratory, Training & Medical, Baskent University Hospital, Adana, Turkey

    Hakan Ozdogu

  14. Hematology Department, University Hospital La Fe, Valencia, Spain

    Jaime Sanz

  15. Hematology Division, Chaim Sheba Medical Center, Tel-Hashomer, Israel

    Arnon Nagler

  16. Department of Hematology, Hospital Saint Antoine, Paris, France

    Mohamad Mohty

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  1. Ryszard Swoboda
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Contributions

RS and SG interpreted results and wrote the manuscript. ML performed the statistical analysis. RS, SG, TS, NK, MA, BS, AS, RMH, VP, AB, IYA, AR, HO, JS, AN, and MM provided patient data and reviewed the final version of the manuscript. SG, BS, AS, AN, and MM designed the study and interpreted the results.

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Correspondence to Ryszard Swoboda.

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Swoboda, R., Labopin, M., Giebel, S. et al. Total body irradiation plus fludarabine versus busulfan plus fludarabine as a myeloablative conditioning for adults with acute myeloid leukemia treated with allogeneic hematopoietic cell transplantation. A study on behalf of the Acute Leukemia Working Party of the EBMT. Bone Marrow Transplant 58, 282–287 (2023). https://doi.org/10.1038/s41409-022-01882-5

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