Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
Division of Hematology, National Hospital Organization Toyohashi Medical Center, Toyohashi, Japan.
Biol Blood Marrow Transplant. 2017 Dec;23(12):2079-2087. doi: 10.1016/j.bbmt.2017.09.003. Epub 2017 Sep 7.
The optimal conditioning regimen for elderly patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HCT) remains unclear. We retrospectively analyzed 1607 patients aged 50 years or older with acute myeloid leukemia (AML), acute lymphoblastic leukemia, or myelodysplastic syndrome (MDS) who underwent allo-HCT using fludarabine/busulfan (FB) or fludarabine/melphalan (FM) between 2007 and 2014. We compared the clinical outcomes among FB2 (busulfan at 6.4 mg/kg iv, n = 463), FB4 (busulfan at 12.8 mg/kg iv, n = 721), and FM140 (melphalan at 140 mg/m, n = 423). The nonrelapse mortality (NRM) rates in the FB4 and FM140 groups were higher than that in the FB2 group (hazard ratio [HR], 1.63 [P < .001]; and HR, 1.71 [P < .001], respectively). Conversely, the relapse rates in the FB4 and FM140 groups were lower than that in the FB2 group (HR, .73 [P = .011]; and HR, .56 [P < .001], respectively). There were no significant differences in overall survival (OS) among the FB2, FB4, and FM140 groups. The 3-year OS in patients with high-risk AML and MDS in the FM140 group (37.0% and 60.2%) were superior to those in the FB2 group (24.4% and 45.5%) and the FB4 group (24.6% and 40.6%) (P = .016 and P = .023), whereas there were no differences in OS in the other patients among the 3 groups. In conclusion, the lower rates of relapse in the FB4 and FM140 groups were largely offset by a worse NRM. However, FM140 might be associated with better OS in patients with high-risk AML and MDS.
对于接受异基因造血干细胞移植（allo-HCT）的老年患者，最佳的预处理方案仍不明确。我们回顾性分析了 2007 年至 2014 年间接受 allo-HCT 的 1607 例年龄 50 岁或以上的急性髓系白血病（AML）、急性淋巴细胞白血病或骨髓增生异常综合征（MDS）患者，预处理方案为氟达拉滨/白消安（FB）或氟达拉滨/马法兰（FM）。我们比较了 FB2（静脉注射 6.4mg/kg 白消安，n=463）、FB4（静脉注射 12.8mg/kg 白消安，n=721）和 FM140（马法兰 140mg/m，n=423）三组的临床结局。FB4 组和 FM140 组的非复发死亡率（NRM）均高于 FB2 组（风险比 [HR]，1.63[P<0.001]；和 HR，1.71[P<0.001]）。相反，FB4 组和 FM140 组的复发率均低于 FB2 组（HR，0.73[P=0.011]；和 HR，0.56[P<0.001]）。FB2、FB4 和 FM140 三组的总生存率（OS）无显著差异。FM140 组高危 AML 和 MDS 患者的 3 年 OS（37.0%和 60.2%）优于 FB2 组（24.4%和 45.5%）和 FB4 组（24.6%和 40.6%）（P=0.016 和 P=0.023），而其他患者三组之间的 OS 无差异。总之，FB4 和 FM140 组复发率较低，但 NRM 较高，在很大程度上抵消了这一优势。然而，FM140 可能与高危 AML 和 MDS 患者的 OS 改善有关。
