Busulfan and melphalan as conditioning regimen for allogeneic hematopoietic stem cell transplantation in acute myeloid leukemia in first complete remission

Revista Brasileira de Hematologia e Hemoterapia

Nadjanara Dorna Bueno²  Frederico Luiz Dulley²  Rosaura Saboya²  José Ulysses Amigo Filho²  Fabio Luiz Coracin²  Dalton De Alencar Fischer Chamone¹ 

[1] ,Universidade de São Paulo Faculdade de Medicina Hospital das ClínicasSão Paulo SP ,Brazil

关键词: Stem cell transplantation;    Leukemia;    myeloid;    acute;    Drug toxicity;    Bone marrow transplantation;    Busulfan;    Combined modality therapy;    Cyclophosphamide;    Graft vs. Host disease;    Survival analysis;    Prognosis;   

DOI  :  10.5581/1516-8484.20110050

来源: SciELO

【 摘 要 】

BACKGROUND: Allogeneic hematopoietic stem cell transplantation with HLA-identical donors has been established for the treatment of acute myeloid leukemia patients for over 30 years with a cure rate of 50% to 60%. OBJECTIVES: To analyze the overall survival of patients and identify factors that influence the outcomes of this type of transplant in patients in 1st complete remission who received a busulfan and melphalan combination as conditioning regimen. METHODS: Twenty-five consecutive patients with acute myeloid leukemia were enrolled between 2003 and 2008. The median age was 34 years old (Range: 16 - 57 years). All patients received cyclosporine and methotrexate for prophylaxis against graft-versus-host disease. Median neutrophil engraftment time was 16 days (Range: 7 - 22 days) and 17 days (Range: 7 - 46 days) for platelets. Sinusoidal obstructive syndrome was observed in three patients, seven had grade II acute graft-versus-host disease and one extensive chronic graft-versus-host disease. RESULTS: The overall survival by the Kaplan-Meier method was 48% after 36 months with a plateau at 36 months after transplantation. Intensive consolidation with high-dose arabinoside resulted in an improved survival (p-value = 0.0001), as did grade II acute graft-versus-host disease (p-value = 0.0377) and mild chronic graft-versus-host disease (p-value < 0.0001). Thirteen patients died, five due to infection within 100 days of transplant, two due to hemorrhages, one to infection and graftversus-host disease and three relapses followed by renal failure (one) and infection (two). The cause of death could not be determined for two patients. CONCLUSION: The busulfan and melphalan conditioning regimen is as good as other conditioning regimens providing an excellent survival rate.

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