Reduced-Intensity Conditioning with Busulfan and Fludarabine for Allogeneic Hematopoietic Stem Cell Transplantation in Acute Lymphoblastic Leukemia

• Published in: Yonsei medical journal Vol. 61; no. 6; pp. 452 - 459
• Main Authors: Lee, Seung Shin, Jung, Sung Hoon, Do, Young Rok, Kim, Dae Sik, Lee, Ji Hyun, Park, Han Seung, Moon, Joon Ho, Yi, Jun Ho, Park, Yong, Koh, Youngil, Yhim, Ho Young, Choi, Yunsuk, Mun, Yeung Chul, Lee, Won Sik, Lee, Seok, Yang, Deok Hwan
• Format: Journal Article
• Language: English
• Published: Korea (South) Yonsei University College of Medicine 01-06-2020; 연세대학교의과대학
• Subjects: Original; 의학일반; busulfan; Fludarabine; lymphoblastic leukemia; stem cell transplantation; transplantation conditioning
• ISSN: 0513-5796; 1976-2437
• DOI: 10.3349/ymj.2020.61.6.452

Allogeneic hematopoietic stem cell transplantation (HSCT) with optimal conditioning has helped better long-term survival in acute lymphoblastic leukemia (ALL). This study investigated the efficacy and safety of reduced-intensity conditioning (RIC) with busulfan and fludarabine in adult ALL patients unfit for myeloablation.
Records of 78 patients who underwent HSCT with RIC consisting of 3.2 mg/kg/day of busulfan for 2 or 3 days and 30 mg/m²/day of fludarabine for 5 or 6 days were analyzed.
The median age at diagnosis was 49 years. Over a median follow-up of 22 months, 2-year estimates of relapse-free survival (RFS) and overall survival were 57.4% and 68.7%, respectively. Multivariate analysis showed a trend of improved RFS in patients with chronic graft-versus-host disease (GVHD) (hazard ratio, 0.53; 95% confidence interval, 0.26-1.08;
=0.080). The cumulative incidences of relapse and non-relapse mortality were 42.9% and 19.6%, respectively and one case of central nervous system relapse was noted. No hepatic veno-occlusive disease was reported. Grade II-IV acute GVHD and any grade chronic GVHD occurred in 21.1% and 41.7%, respectively.
RIC with busulfan and fludarabine is an effective and safe conditioning regimen for adult ALL patients unfit for myeloablation.