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Reduced toxicity (FluBu3) versus myeloablative (BuCy) conditioning in acute myeloid leukemia patients who received first allogeneic hematopoietic stem cell transplantation in measurable residual disease-negative CR1

Bone Marrow Transplantation (2024)Cite this article

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Abstract

In the present study, reduced toxicity (FluBu3) and myeloablative (BuCy) conditioning were compared in patients with AML who received first allogeneic HSCT in MRD-negative CR1. The study included 124 adult patients who underwent HSCT from an HLA-matched (8/8) sibling, unrelated, or 1-locus mismatched (7/8) unrelated donor (MMUD). The median age was 45 years and intermediate cytogenetics comprised majority (71.8%). The 2-year OS, RFS, CIR and NRM for BuCy (n = 78, 62.9%) and FluBu3 (n = 46, 37.1%) groups were 78.3% and 84.5% (p = 0.358), 78.0% and 76.3% (p = 0.806), 7.7% and 21.5% (p = 0.074) and 14.3% and 2.2% (p = 0.032), respectively. At the time of data cut-off, relapse and NRM were the main causes of HSCT failure in each of the FluBu3 and BuCy arms. Among patients, 75% of relapsed FluBu3 patients had high-risk features of either poor cytogenetics or FLT3-ITD mutation compared with 16.7% of BuCy patients. The majority of NRM in the BuCy group was due to GVHD (73%), half of whom received MMUD transplantation. To conclude, the FluBu3 reduced toxicity conditioning showed comparable post-transplant OS and RFS to BuCy and was associated with significantly reduced NRM that was offset by a trend towards higher risk of relapse even in MRD-negative CR1 population.

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Fig. 1: Post-transplant outcomes in BuCy and FluBu3 groups.
Fig. 2: Post-transplant GVHD and GRFS in BuCy and FluBu3 groups.

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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 thank all patients and their families for their participation in the trial.

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Authors and Affiliations

  1. Department of Hematology, Catholic Hematology Hospital, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea

    Silvia Park, Su-Yeon Bang, Daehun Kwag, Gi June Min, Sung Soo Park, Jae-Ho Yoon, Sung-Eun Lee, Byung Sik Cho, Ki-Seong Eom, Yoo-Jin Kim, Seok Lee, Chang-Ki Min, Seok-Goo Cho, Jong Wook Lee & Hee-Je Kim

  2. Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea

    Silvia Park, Gi June Min, Sung Soo Park, Jae-Ho Yoon, Sung-Eun Lee, Byung Sik Cho, Ki-Seong Eom, Yoo-Jin Kim, Seok Lee, Chang-Ki Min & Hee-Je Kim

  3. Department of Hematology, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea

    Jong Hyuk Lee & Seung-Ah Yahng

  4. Department of Hematology, Yeoido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea

    Tong Yoon Kim & Young-Woo Jeon

  5. Department of Hematology, Catholic Hematology Hospital, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea

    Joonyeop Lee & Seung-Hwan Shin

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Contributions

HJK conceived the idea and designed the study. SP collected and analyzed data and wrote the manuscript. HJK, SP, and BSC provided patients and study materials. SYB, DK, JHL, TYK, JL, and GJM contributed to data extraction and provided feedback on the report. SSP, SAY, YWJ, SHS, JHY, SEL, KSE, YJK, SL, CKM, SGC, and JWL provided feedback on the report.

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Correspondence to Hee-Je Kim.

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Park, S., Bang, SY., Kwag, D. et al. Reduced toxicity (FluBu3) versus myeloablative (BuCy) conditioning in acute myeloid leukemia patients who received first allogeneic hematopoietic stem cell transplantation in measurable residual disease-negative CR1. Bone Marrow Transplant (2024). https://doi.org/10.1038/s41409-024-02255-w

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