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
Affiliations
Arnon Nagler
Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel Hashomer, Israel
Myriam Labopin
Acute Leukemia Working Party -EBMT, Hôpital Saint Antoine, AP-HP, Université Pierre et Marie Curie Paris 6 UPMC, INSERM UMR-S 938, Paris, France
Norbert-Claude Gorin
Acute Leukemia Working Party -EBMT, Hôpital Saint Antoine, AP-HP, Université Pierre et Marie Curie Paris 6 UPMC, INSERM UMR-S 938, Paris, France;Department of Hematology and Cell Therapy, Hospital Saint Antoine, Paris, France
Felicetto Ferrara
Cardarelli Hospital, Napoli, Italy
Miguel A Sanz
Hospital Universitario La Fe, University of Valencia, Spain
Depei Wu
First Affiliated Hospital of Soochow University, Suzhou, China
Antonio Torres Gomez
Hospital Reina Sofia, Córdoba, Spain
Simona Lapusan
Department of Hematology and Cell Therapy, Hospital Saint Antoine, Paris, France
Giuseppe Irrera
Azienda Ospedaliera, Reggio Calabria, Italy
Jose E Guimaraes
Hospital Sao Joao and School of Medicine, Porto, Portugal
Aida Botelho Sousa
Hospital dos Capuchos, Lisboa, Portugal
Angelo M. Carella
Hospital San Martino, Genova, Italy
Norbert Vey
Centre Paoli Calmettes, Marseille, France
William Arcese
Rome Transplant Network, Rome, Italy
Avichai Shimoni
Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel Hashomer, Israel
Raanan Berger
Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel Hashomer, Israel
Vanderson Rocha
Churchill Hospital, Oxford University, UK
Mohamad Mohty
Acute Leukemia Working Party -EBMT, Hôpital Saint Antoine, AP-HP, Université Pierre et Marie Curie Paris 6 UPMC, INSERM UMR-S 938, Paris, France;Department of Hematology and Cell Therapy, Hospital Saint Antoine, Paris, France
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