Prospective cohort study comparing intravenous busulfan to total body irradiation in hematopoietic cell transplantation. Blood 2013 Dec 05;122(24):3871-8
Date
10/02/2013Pubmed ID
24081656Pubmed Central ID
PMC3854109DOI
10.1182/blood-2013-08-519009Scopus ID
2-s2.0-84887535514 (requires institutional sign-in at Scopus site) 127 CitationsAbstract
We conducted a prospective cohort study testing the noninferiority of survival of ablative intravenous busulfan (IV-BU) vs ablative total body irradiation (TBI)-based regimens in myeloid malignancies. A total of 1483 patients undergoing transplantation for myeloid malignancies (IV-BU, N = 1025; TBI, N = 458) were enrolled. Cohorts were similar with respect to age, gender, race, performance score, disease, and disease stage at transplantation. Most patients had acute myeloid leukemia (68% IV-BU, 78% TBI). Grafts were primarily peripheral blood (77%) from HLA-matched siblings (40%) or well-matched unrelated donors (48%). Two-year probabilities of survival (95% confidence interval [CI]), were 56% (95% CI, 53%-60%) and 48% (95% CI, 43%-54%, P = .019) for IV-BU (relative risk, 0.82; 95% CI, 0.68-0.98, P = .03) and TBI, respectively. Corresponding incidences of transplant-related mortality (TRM) were 18% (95% CI, 16%-21%) and 19% (95% CI, 15%-23%, P = .75) and disease progression were 34% (95% CI, 31%-37%) and 39% (95% CI, 34%-44%, P = .08). The incidence of hepatic veno-occlusive disease (VOD) was 5% for IV-BU and 1% with TBI (P < .001). There were no differences in progression-free survival and graft-versus-host disease. Compared with TBI, IV-BU resulted in superior survival with no increased risk for relapse or TRM. These results support the use of myeloablative IV-BU vs TBI-based conditioning regimens for treatment of myeloid malignancies.
Author List
Bredeson C, LeRademacher J, Kato K, Dipersio JF, Agura E, Devine SM, Appelbaum FR, Tomblyn MR, Laport GG, Zhu X, McCarthy PL, Ho VT, Cooke KR, Armstrong E, Smith A, Rizzo JD, Burkart JM, Pasquini MCAuthors
Marcelo C. Pasquini MD, MS Professor in the Medicine department at Medical College of WisconsinJ. Douglas Rizzo MD, MS Director, Center Associate Director, Professor in the Medicine department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
Acute DiseaseAdministration, Intravenous
Adolescent
Adult
Antineoplastic Combined Chemotherapy Protocols
Busulfan
Child
Child, Preschool
Combined Modality Therapy
Cyclophosphamide
Female
Hematopoietic Stem Cell Transplantation
Humans
Infant
Leukemia, Myeloid
Male
Middle Aged
Proportional Hazards Models
Prospective Studies
Survival Analysis
Whole-Body Irradiation
Young Adult
