Haematologica (Aug 2014)

Intravenous busulfan for autologous stem cell transplantation in adult patients with acute myeloid leukemia: a survey of 952 patients on behalf of the Acute Leukemia Working Party of the European Group for Blood and Marrow Transplantation

  • Arnon Nagler,
  • Myriam Labopin,
  • Norbert-Claude Gorin,
  • Felicetto Ferrara,
  • Miguel A Sanz,
  • Depei Wu,
  • Antonio Torres Gomez,
  • Simona Lapusan,
  • Giuseppe Irrera,
  • Jose E Guimaraes,
  • Aida Botelho Sousa,
  • Angelo M. Carella,
  • Norbert Vey,
  • William Arcese,
  • Avichai Shimoni,
  • Raanan Berger,
  • Vanderson Rocha,
  • Mohamad Mohty

DOI
https://doi.org/10.3324/haematol.2014.105197
Journal volume & issue
Vol. 99, no. 8

Abstract

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Oral busulfan is the historical backbone of the busulfan+cyclophosphamide regimen for autologous stem cell transplantation. However intravenous busulfan has more predictable pharmacokinetics and less toxicity than oral busulfan; we, therefore, retrospectively analyzed data from 952 patients with acute myeloid leukemia who received intravenous busulfan for autologous stem cell transplantation. Most patients were male (n=531, 56%), and the median age at transplantation was 50.5 years. Two-year overall survival, leukemia-free survival, and relapse incidence were 67±2%, 53±2%, and 40±2%, respectively. The non-relapse mortality rate at 2 years was 7±1%. Five patients died from veno-occlusive disease. Overall leukemia-free survival and relapse incidence at 2 years did not differ significantly between the 815 patients transplanted in first complete remission (52±2% and 40±2%, respectively) and the 137 patients transplanted in second complete remission (58±5% and 35±5%, respectively). Cytogenetic risk classification and age were significant prognostic factors: the 2-year leukemia-free survival was 63±4% in patients with good risk cytogenetics, 52±3% in those with intermediate risk cytogenetics, and 37 ± 10% in those with poor risk cytogenetics (P=0.01); patients ≤50 years old had better overall survival (77±2% versus 56±3%; P