Survival advantage of treosulfan plus fludarabine (FT14) compared to busulfan plus fludarabine (FB4) in active acute myeloid leukemia post allogeneic transplantation: an analysis from the European Society for Blood and Marrow Transplantation (EBMT) Acute Leukemia Working Party (ALWP)

Gavriilaki, Eleni ; Sakellari, Ioanna ; Labopin, Myriam ; Bornhäuser, Martin ; Hamladji, Rose-Marie ; Casper, Jochen ; Edinger, Matthias ; Zák, Pavel ; Yakoub-Agha, Ibrahim ; Ciceri, Fabio ; Schroeder, Thomas ; Zuckerman, Tsila ; Kobbe, Guido ; Yeshurun, Moshe ; Narni, Franco ; Finke, Jürgen ; Diez-Martin, Jose Luiz ; Berceanu, Ana ; Hilgendorf, Inken ; Verbeek, Mareike ; Olivieri, Attilio ; Savani, Bipin ; Spyridonidis, Alexandros ; Nagler, Arnon ; Mohty, Mohamad

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Details

Item type:	Article
Journal or Publication Title:	Bone Marrow Transplantation
Publisher:	SPRINGERNATURE
Place of Publication:	LONDON
Volume:	58
Number of Issue or Book Chapter:	10
Page Range:	pp. 1084-1088
Date:	2023
Institutions:	Medicine > Lehrstuhl für Innere Medizin III (Hämatologie und Internistische Onkologie)
Identification Number:	Value Type 10.1038/s41409-023-02028-x DOI
Dewey Decimal Classification:	600 Technology > 610 Medical sciences Medicine
Status:	Published
Refereed:	Yes, this version has been refereed
Created at the University of Regensburg:	Yes
Item ID:	76225

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Abstract

We compared FT14 (fludarabine 150-160 mg/m(2), treosulfan 42 g/m(2)) versus FB4 (fludarabine 150-160 mg/m(2), busulfan 12.8 mg/kg) in acute myeloid leukemia (AML) transplanted at primary refractory/relapsed disease. We retrospectively studied: (a) adults diagnosed with AML, (b) recipients of first allogeneic hematopoietic stem cell transplantation (HSCT) from unrelated/sibling donor (2010-2020), ...

Abstract

We compared FT14 (fludarabine 150-160 mg/m(2), treosulfan 42 g/m(2)) versus FB4 (fludarabine 150-160 mg/m(2), busulfan 12.8 mg/kg) in acute myeloid leukemia (AML) transplanted at primary refractory/relapsed disease. We retrospectively studied: (a) adults diagnosed with AML, (b) recipients of first allogeneic hematopoietic stem cell transplantation (HSCT) from unrelated/sibling donor (2010-2020), (c) HSCT with primary refractory/relapsed disease, (d) conditioning regimen with FT14 or FB4. We studied 346 patients, 113 transplanted with FT14, and 233 with F & UBeta;4. FT14 patients were significantly older, more frequently had an unrelated donor and had received a lower dose of fludarabine. Cumulative incidence (CI) of acute graft-versus-host disease (GVHD) grade III-IV and extensive chronic GVHD was similar. With a median follow-up of 28.7 months, 2-year CI of relapse was 43.4% in FT14 versus 53.2% in FB4, while non-relapse mortality (NRM) was respectively 20.8% versus 22.6%. This led to 2-year leukemia-free survival (LFS) of 35.8% for FT14 versus 24.2% in FB4, and overall survival (OS) of 44.4% versus 34%. Adverse cytogenetics and conditioning regimen independently predicted CI of relapse. Furthermore, conditioning regimen was the only independent predictor of LFS, OS, and GVHD-free/relapse-free survival. Therefore, our real-world multicenter study suggests that FT14 is associated with better outcomes in primary refractory/relapsed AML.

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