Korean J Hematol.  2010 Jun;45(2):102-108. 10.5045/kjh.2010.45.2.102.

Fludarabine-based myeloablative regimen as pretransplant conditioning therapy in adult acute leukemia/myelodysplastic syndrome: comparison with oral or intravenous busulfan with cyclophosphamide

• Lee JH
• Choi J
• Kwon KA
• Lee S
• Oh SY
• Kwon HC
• Kim HJ
• Han JY
• Kim SH

• KMID: 2083542
• DOI: http://doi.org/10.5045/kjh.2010.45.2.102

Abstract

BACKGROUND
A combination of busulfan (Bu) and cyclophosphamide (Cy) has been used as a standard myeloablative regimen for allogeneic hematopoietic stem cell transplantation (HSCT). Recent studies postulate that fludarabine (Flu) is a less toxic substitute for Cy.
METHODS
Forty-two patients who were diagnosed with acute leukemia or myelodysplastic syndrome and received BuFlu (n=17) or BuCy (n=25) from August, 1999 to July, 2009 at Dong-A University Medical Center were retrospectively analyzed.
RESULTS
The median follow-up duration was 39.75 months. The BuFlu group showed a lower incidence of mucositis (P=0.005), but there was no significant intergroup difference in the time of engraftment, nausea/vomiting, acute/chronic graft-versus-host disease, hepatic veno-occlusive disease, or hemorrhagic cystitis. Moreover, the 2 groups showed no significant difference in the cumulative risk of relapse, event-free survival, or overall survival.
CONCLUSION
BuFlu administration can be employed as a preparative regimen for allogeneic HSCT and shows efficacy and transplant-adverse effects comparable to those of BuCy. However, randomized prospective studies in more patients are warranted.

Keyword

Myeloablative regimen; Allogeneic hematopoietic stem cell transplantation; Fludarabine; Busulfan

MeSH Terms

Academic Medical Centers
Adult
Behavior Therapy
Busulfan
Cyclophosphamide
Cystitis
Disease-Free Survival
Follow-Up Studies
Graft vs Host Disease
Hematopoietic Stem Cell Transplantation
Hepatic Veno-Occlusive Disease
Humans
Incidence
Leukemia
Mucositis
Myelodysplastic Syndromes
Recurrence
Retrospective Studies
Vidarabine
Busulfan
Cyclophosphamide
Vidarabine

Figure

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  Fig. 1 Cumulative risk of relapse.

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  Fig. 2 Overall survival (A) and event-free survival (B).

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