Contributions
Abstract: PB2454
Type: Publication Only
Background
Reduced intensity conditioning (RIC) allogeneic haematopoietic stem cell transplantation (allo-HSCT) is an effective treatment for high risk MDS and AML, but the optimal conditioning regimen remains debatable. FluMel (Fludarabine 150mg/m2, melphalan 140mg/m2) replaced FluBu (Fludarabine 150mg/m2, Busulfan 9.6mg/kg IV) as the standard RIC regimen for myeloid malignancy in our centre due to perceived elevated transplant-related mortality. All RIC transplants are T-cell depleted with standard doses of alemtuzumab.
Aims
To determine whether the use of busulfan or melphalan with fludarabine in RIC allo-HSCT for MDS/AML had a significant impact on outcomes in our centre.
Methods
Outcomes pertaining to consecutive MDS/AML patients transplanted with fludarabine and either busulfan (FluBu) or melphalan (FluMel) based RIC over a 2-year period in a single centre were retrospectively analysed, including demographics, Karnofsky performance status (KPS), engraftment, graft-versus-host disease (GVHD), and mortality. Statistical analysis was conducted using Student’s t-test and Fisher’s exact test.
Results
Between May 2015 and May 2017, 44 patients underwent RIC allo-HSCT for MDS/AML. Twenty-two (50%) patients received FluBu and 22 patients received FluMel. In the FluBu group, 9 (41%) patients were male, with an average age of 56 years (range 31-71) and KPS range of 90-100. Ten (45%) patients died, 5 (50%) of which due to relapse and the remainder (50%) due to infection, within an average of 255 days from transplant (range 37-608). In the FluMel group, 13 (59%) patients were male, with an average age of 57 years (range 40-69), and KPS range of 80-100. Seven (32%) patients died, 2 (29%) of which due to relapse, and the remainder (71%) due to infection, within an average of 198 days from transplant (range 44-428). Average time to engraftment was 15.1 and 15.5 days in the FluBu and FluMel groups, respectively. Eleven (50%) patients in the FluBu group and 9 (41%) in the FluMel group developed GVHD (grades II-IV). There was no significant difference in survival or non-relapse mortality (NRM) between both groups (p=0.5365 and p=0.6221, respectively).
Conclusion
In a uniform MDS/AML cohort, we have demonstrated no significant difference in outcomes between T-cell depleted fludarabine/busulfan and fludarabine/melphalan RIC allo-HSCT. However, more studies are needed with larger samples and longer follow-up times.
Session topic: 23. Stem cell transplantation - Clinical
Keyword(s): Busulfan, MDS/AML, Melphalan, Stem cell transplant
Abstract: PB2454
Type: Publication Only
Background
Reduced intensity conditioning (RIC) allogeneic haematopoietic stem cell transplantation (allo-HSCT) is an effective treatment for high risk MDS and AML, but the optimal conditioning regimen remains debatable. FluMel (Fludarabine 150mg/m2, melphalan 140mg/m2) replaced FluBu (Fludarabine 150mg/m2, Busulfan 9.6mg/kg IV) as the standard RIC regimen for myeloid malignancy in our centre due to perceived elevated transplant-related mortality. All RIC transplants are T-cell depleted with standard doses of alemtuzumab.
Aims
To determine whether the use of busulfan or melphalan with fludarabine in RIC allo-HSCT for MDS/AML had a significant impact on outcomes in our centre.
Methods
Outcomes pertaining to consecutive MDS/AML patients transplanted with fludarabine and either busulfan (FluBu) or melphalan (FluMel) based RIC over a 2-year period in a single centre were retrospectively analysed, including demographics, Karnofsky performance status (KPS), engraftment, graft-versus-host disease (GVHD), and mortality. Statistical analysis was conducted using Student’s t-test and Fisher’s exact test.
Results
Between May 2015 and May 2017, 44 patients underwent RIC allo-HSCT for MDS/AML. Twenty-two (50%) patients received FluBu and 22 patients received FluMel. In the FluBu group, 9 (41%) patients were male, with an average age of 56 years (range 31-71) and KPS range of 90-100. Ten (45%) patients died, 5 (50%) of which due to relapse and the remainder (50%) due to infection, within an average of 255 days from transplant (range 37-608). In the FluMel group, 13 (59%) patients were male, with an average age of 57 years (range 40-69), and KPS range of 80-100. Seven (32%) patients died, 2 (29%) of which due to relapse, and the remainder (71%) due to infection, within an average of 198 days from transplant (range 44-428). Average time to engraftment was 15.1 and 15.5 days in the FluBu and FluMel groups, respectively. Eleven (50%) patients in the FluBu group and 9 (41%) in the FluMel group developed GVHD (grades II-IV). There was no significant difference in survival or non-relapse mortality (NRM) between both groups (p=0.5365 and p=0.6221, respectively).
Conclusion
In a uniform MDS/AML cohort, we have demonstrated no significant difference in outcomes between T-cell depleted fludarabine/busulfan and fludarabine/melphalan RIC allo-HSCT. However, more studies are needed with larger samples and longer follow-up times.
Session topic: 23. Stem cell transplantation - Clinical
Keyword(s): Busulfan, MDS/AML, Melphalan, Stem cell transplant