Comparative analysis of BU and CY versus CY and TBI in full intensity unrelated marrow donor transplantation for AML, CML and myelodysplasia.

Publication Type:

Journal Article

Source:

Bone marrow transplantation, Volume 46, Issue 1, p.34-43 (2011)

Keywords:

2011, Adolescent, Adult, Antineoplastic Combined Chemotherapy Protocols, Bone Marrow Transplantation, Busulfan, Child, Child, Preschool, Combined Modality Therapy, Cyclophosphamide, Female, Humans, Infant, Leukemia, Myeloid, Leukemia, Myeloid, Acute, Leukemia, Myeloid, Chronic-Phase, Male, Middle Aged, Myeloablative Agonists, Myelodysplastic Syndromes, Retrospective Studies, Transplantation Conditioning, Treatment Outcome, Vaccine and Infectious Disease Division, Whole-Body Irradiation, Young Adult

Abstract:

We retrospectively compared clinical outcomes in 1593 T-replete unrelated donor (URD) marrow transplant recipients with AML, MDS and CML who received myeloablative conditioning regimens of either BU and CY (BuCy), standard-dose Cy/TBI (1000-1260 cGy) or high-dose Cy/TBI (1320-1500 cGy). Subjects were drawn from patients transplanted between 1991 and 1999 facilitated by the National Marrow Donor Program. Patients who received high-dose Cy/TBI regimens were slightly younger, more likely to receive a mismatched transplant and to have intermediate or advanced disease compared with patients in the BuCy or standard-dose TBI group. Neutrophil recovery was significantly higher in the standard-dose CY/TBI group compared with the high-dose Cy/TBI or BuCy group. Patients who received the high-dose Cy/TBI regimen had an increased risk of developing grades III-IV aGVHD when compared with the control group who received BuCy (P = 0.011). OS, disease-free survival (DFS), TRM and relapse were not significantly different between any of the regimens. We conclude that BuCy, standard-dose and high-dose Cy/TBI regimens have equivalent efficacy profiles for OS, DFS, TRM and relapse risk in patients undergoing T-replete URD marrow transplantation for AML, CML and MDS.