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Cyclophosphamide plus busulfan improves survival after AML remission
Patients with acute myelogenous leukemia in first remission treated with cyclophosphamide plus busulfan experienced longer leukemia-free survival and OS than those treated with cyclophosphamide plus total body irradiation, according to results of a retrospective study.
Cyclophosphamide plus busulfan or total body irradiation (TBI) are the most commonly used myeloablative conditioning regimens for allogeneic hematopoietic cell transplantation, but data comparing their effectiveness are lacking, according to background information in the study.
For this reason, researchers pooled data from the Center for International Blood and Marrow Transplant Research on 1,230 patients with AML in first complete remission who underwent hematopoietic stem cell transplant from a human-leukocyte antigen-matched sibling or unrelated donor between 2000 and 2006. The study included patients treated at 283 centers.
Patients underwent conditioning with cyclophosphamide plus IV busulfan (n=586), cyclophosphamide plus oral busulfan (n=408), or cyclophosphamide plus TBI (n=236).
Survival served as the primary endpoint. Median follow-up was 5 years.
Researchers observed longer OS (RR=0.68; 95% CI: 0.52–0.88) and leukemia-free survival (RR=0.70; 95% CI, 0.55–0.88) in those treated with cyclophosphamide plus IV busulfan compared with those who received TBI. Cyclophosphamide plus IV busulfan also was associated with significantly reduced nonrelapse mortality (RR=0.58; 95% CI, 0.39–0.86) and less relapse after 1 year of transplant (RR=0.23; 95% CI, 0.08-0.65) compared with TBI.
Cyclophosphamide plus oral busulfan did not confer the same benefits, researchers wrote.
“In the absence of a prospective randomized comparison of cyclophosphamide plus total body irradiation and IV busulfan plus cyclophosphamide using contemporary administration, dosing and supportive care, we suggest that IV busulfan should be utilized in preference to total body irradiation in patients with AML in first complete remission undergoing HCT from matched-related or matched-unrelated donors,” the researchers wrote.