Korean J Intern Med.  2012 Mar;27(1):72-83. 10.3904/kjim.2012.27.1.72.

Feasibility of Non-TBI Conditioning with Busulfan and Fludarabine for Allogeneic Stem Cell Transplantation in Lymphoid Malignancy

• Shin HC
• Lee YJ
• Moon JH
• Lee SJ
• Kang BW
• Chae YS
• Kim JG
• Choi JY
• Seo JW
• Kim YK
• Suh JS
• Sohn SK

• KMID: 1776569
• DOI: http://doi.org/10.3904/kjim.2012.27.1.72

Abstract

BACKGROUND/AIMS
This retrospective study evaluated the transplantation outcomes of patients with adult lymphoid malignancies who received chemotherapy-based conditioning with busulfan and fludarabine (BuFlu) and busulfan and cyclophosphamide (BuCy2).
METHODS
Thirty-eight patients (34 with acute lymphoblastic leukemia and 4 with lymphoblastic lymphoma) were included in the current study. The conditioning regimen was BuCy2 for 14 patients and BuFlu for the remaining 24 patients. Eight and 13 patients were high risk disease in the BuCy2 and BuFlu groups, respectively.
RESULTS
The cumulative incidence of grade II-IV acute graft-versus-host disease (GVHD) was 56.5% and 55.2% and that of extensive chronic GVHD 17.0% and 55.6% (p = 0.018) for the BuFlu and BuCy2 groups, respectively. The 3-year relapse rate was 27.8% and 31.4% and 3-year overall survival 34.3% and 46.8% for the BuFlu and BuCy2 groups, respectively. Treatment-related mortality (TRM) was significantly lower in the BuFlu group (16.9%) than in the BuCy2 group (57.1%, p = 0.010). In multivariate analyses, the BuFlu regimen was identified as an independent favorable risk factor for TRM (hazard ratio [HR], 0.036; p = 0.017) and extensive chronic GVHD (HR, 0.168; p = 0.034).
CONCLUSIONS
Our BuFlu regimen would appear to be an acceptable conditioning option for lymphoid malignancies, including high-risk diseases. It was safely administered with a lower TRM rate than BuCy2 conditioning.

Keyword

Precursor cell lymphoblastic leukemia-lymphoma; Busulfan; Drug therapy; Fludarabine

MeSH Terms

Adolescent
Adult
Busulfan/adverse effects/*therapeutic use
Chi-Square Distribution
Disease-Free Survival
Drug Therapy, Combination
Feasibility Studies
Female
Graft vs Host Disease/etiology
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Multivariate Analysis
Myeloablative Agonists/adverse effects/*therapeutic use
Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy/mortality/surgery/*therapy
Proportional Hazards Models
Republic of Korea
Retrospective Studies
Risk Assessment
Risk Factors
*Stem Cell Transplantation/adverse effects/mortality
Time Factors
Transplantation Conditioning/adverse effects/*methods/mortality
Transplantation, Homologous
Treatment Outcome
Vidarabine/adverse effects/*analogs & derivatives/therapeutic use
Young Adult