Department of Pharmacy, Moffitt Cancer Center, Tampa, FL, USA.
Biostatistics Core, Moffitt Cancer Center, Tampa, FL, USA.
Leuk Lymphoma. 2020 Jul;61(7):1678-1687. doi: 10.1080/10428194.2020.1731498. Epub 2020 Mar 5.
Optimal conditioning chemotherapy for patients with acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) remains uncertain. Myeloablative regimens such as fludarabine/busulfan are favored over reduced-intensity fludarabine/melphalan (Flu/Mel); however, it is not known if Flu/Mel is inferior. We analyzed hematopoietic cell transplantation recipients with AML and MDS who received fludarabine with once-daily intravenous busulfan targeted to either area under the curve (AUC) 5300 µML/min (Flu/Bu 5300) ( = 246) or AUC 3500 µML/min (Flu/Bu 3500) ( = 81), or Flu/Mel ( = 69). Flu/Bu regimens were compared separately to Flu/Mel. After 2-year follow-up, no differences in overall or relapse-free survival were found between Flu/Bu 5300 or 3500 versus Flu/Mel though relapse rates were significantly higher; 33.1% ( = 0.024), 44.6% ( = 0.002), versus 19.4%, respectively. Flu/Bu 5300 ( = 0.008) and Flu/Bu 3500 ( < 0.001) groups were prognostic for relapse compared to Flu/Mel. Flu/Mel yields lower relapse rates and similar survival benefit when compared to Flu/Bu 3500 or 5300 µM*L/min.
对于急性髓系白血病（AML）和骨髓增生异常综合征（MDS）患者，最佳的预处理化疗方案仍不确定。与强度降低的氟达拉滨/马利兰（Flu/Mel）相比，人们更倾向于采用氟达拉滨/白消安等清髓性方案；然而，目前尚不清楚 Flu/Mel 是否劣效。我们分析了接受氟达拉滨联合每日静脉注射白消安预处理的 AML 和 MDS 造血细胞移植受者，白消安的目标曲线下面积（AUC）分别为 5300µML/min（Flu/Bu 5300）（ = 246）或 3500µML/min（Flu/Bu 3500）（ = 81），或 Flu/Mel（ = 69）。分别比较了 Flu/Bu 方案与 Flu/Mel。在 2 年的随访后，Flu/Bu 5300 或 3500 与 Flu/Mel 之间在总生存或无复发生存方面没有差异，但复发率明显更高；分别为 33.1%（ = 0.024）、44.6%（ = 0.002）和 19.4%。与 Flu/Mel 相比，Flu/Bu 5300（ = 0.008）和 Flu/Bu 3500（ < 0.001）组的复发风险更高。与 Flu/Bu 3500 或 5300µM*L/min 相比，Flu/Mel 可降低复发率并获得相似的生存获益。
