Liu Hui, Fan Zhi-ping, Jiang Qian-li, Huang Fen, Zhou Hong-sheng, Zhang Xian, Yu Guo-pan, Wu Mei-qing, Sun Jing, Liu Qi-fa
Institute of Hematology, Nanfang Hospital of Southern Medical University, Guangzhou 510515, China.
Zhonghua Nei Ke Za Zhi. 2012 Nov;51(11):880-4.
To compare the transplant-related toxicity and the efficacy of busulfan/fludarabine (Bu/Flu) and busulfan/cyclophosphamide (Bu/Cy) as conditioning regimen in allogeneic hematopoietic stem cell transplantation (allo-HSCT) for acute myeloid leukemia(AML) in the first complete remission (CR1).
Totally 32 AML-CR1 patients underwent allo-HSCT were divided into Bu/Cy (Bu 3.2 mg×kg(-1)×d(-1), 7 - 4 days before transplantation; Cy 60 mg×kg(-1)×d(-1), 3 - 2 days before transplantation) and Bu/Flu (Bu 3.2 mg×kg(-1)×d(-1), 5 - 2 days before transplantation; Flu 30 mg×m(-2)×d(-1), 6 - 2 days before transplantation) groups. The regimen-related toxicity (RRT), incidence and severity of graft-versus-host disease (GVHD), 3-year cumulative relapse rate, non-relapse mortality (NRM), 3-year event-free survival (EFS) rate and overall survival (OS) rate were compared between the two groups.
The median follow-up duration was 617.5 (6 - 1261) days. All patients achieved successful engraftment on 30 day after transplantation. There were no significant differences in the median time to neutrophil engraftment (P = 0.121) and platelet engraftment (P = 0.171) between the two groups. The median duration of neutrophil count under 0.1×10(9)/L and platelet count under 20×10(9)/L in the Bu/Cy group were significantly longer than those in the Bu/Flu group (P = 0.000 and P = 0.047). The incidence of grades II-IV RRT were 68.8% and 25.0% (P = 0.032) in the Bu/Cy and the Bu/Flu groups, respectively. There were no significant differences in the incidence of acute GVHD (P = 0.149), chronic GVHD (P = 0.149), incidence of NRM (P = 0.333), 3-year cumulative relapse rates (P = 0.834), 3-year EFS rate (P = 0.362) and OS rate (P = 0.111) between the two groups.
Compared with Bu/Cy, Bu/Flu is a myeloablative condition regimen with milder bone marrow suppression and lower RRT incidence rate in allogeneic HSCT for AML-CR1 patients without compromising the efficacy.
比较白消安/氟达拉滨（Bu/Flu）和白消安/环磷酰胺（Bu/Cy）作为预处理方案在急性髓系白血病（AML）首次完全缓解期（CR1）进行异基因造血干细胞移植（allo-HSCT）时的移植相关毒性及疗效。
将32例行allo-HSCT的AML-CR1患者分为Bu/Cy组（白消安3.2mg×kg⁻¹×d⁻¹，移植前7至4天；环磷酰胺60mg×kg⁻¹×d⁻¹，移植前3至2天）和Bu/Flu组（白消安3.2mg×kg⁻¹×d⁻¹，移植前5至2天；氟达拉滨30mg×m⁻²×d⁻¹，移植前6至2天）。比较两组的方案相关毒性（RRT）、移植物抗宿主病（GVHD）的发生率及严重程度、3年累积复发率、非复发死亡率（NRM）、3年无事件生存率（EFS）率和总生存率（OS）率。
中位随访时间为617.5（6至1261）天。所有患者均在移植后30天成功植入。两组中性粒细胞植入中位时间（P = 0.121）和血小板植入中位时间（P = 0.171）无显著差异。Bu/Cy组中性粒细胞计数低于0.1×10⁹/L和血小板计数低于20×10⁹/L的中位持续时间显著长于Bu/Flu组（P = 0.000和P = 0.047）。Bu/Cy组和Bu/Flu组II-IV级RRT的发生率分别为68.8%和25.0%（P = 0.032）。两组急性GVHD发生率（P = 0.149）、慢性GVHD发生率（P = 0.149）、NRM发生率（P = 0.333）、3年累积复发率（P = 0.834）、3年EFS率（P = 0.362）和OS率（P = 0.111）无显著差异。
与Bu/Cy相比，Bu/Flu是一种清髓性预处理方案，在AML-CR1患者的异基因HSCT中骨髓抑制较轻，RRT发生率较低，且不影响疗效。
