A modified busulfan and cyclophosphamide preparative regimen for allogeneic transplantation in myeloid malignancies
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Background Busulfan/cyclophosphamide (Bu/Cy) is commonly used as a standard conditioning regimen without total body irradiation for patients with hematological myeloid malignancies undergoing hematopoietic stem cell transplantation (HSCT). Objective To develop a new myeloablative conditioning regimen incorporating fludarabine (Flu) and cytarabine (Ara-c). Setting A tertiary blood disease hospital in Tianjin, China. Methods A Bu/Cy preparative regimen was used, modified by Flu 90 mg/m2 and Ara-c 6 g/m2 in 57 unselected patients (median age 37 years) with hematological myeloid malignancies. The patients were to receive allogeneic hematopoietic stem cell transplantation (allo-HSCT). Thirteen patients had high-risk leukemia, fifty patients had HLA matched sibling donors while seven patients had HLA mismatched sibling donors. Cy was given 50 mg/kg/day for 2 days while Bu was given 3.2 mg/kg/day intravenously for 3 days. Main outcome measure Post-transplant donor chimerism, relapse tendency and minimal residual disease. Results Extramedullar toxicity was relatively limited; the incidence of treatment-related mortality (TRM) within 100 days was 3.5 %. The incidence of grade II–IV, grade III–IV acute graft versus host disease (GVHD) and chronic GVHD of the evaluable patients were 21.1, 8.8 and 36.4 %, respectively. With a median follow up of 59 (13–96.5) months, TRM and relapse rate (RR) at eight years were 24.1 ± 5.8 and 14.7 ± 4.8 %, respectively. Disease free survival at eight years was 67.9 ± 6.2 % for the entire group, 60.0 ± 8.9 % for patients with AML, 77.3 ± 8.9 % for patients with CML, 70.0 ± 6.5 and 42.9 ± 18.7 % or matched sibling and mismatched sibling HSCT respectively. Conclusion The new regimen was associated with a low relapse rate, low incidence and severity of graft versus host disease and satisfactory survival for patients with myeloid malignancies.
KeywordsBusulfan Conditioning regimen Cytarabine FLAG Fludarabine Graft-versus-host disease Myeloid malignancy Stem cell transplantation
This work was supported by Grants from the National Key Technology Support Program of China (2013BAIO1BO9) and the Key Program of Applied basic Research Foundation of Tianjin (14JCZDJC33000).
Conflicts of interest
The authors have no conflict of interests.
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