Fludarabine, busulfan, and melphalan conditioning regimen in allogeneic hematopoietic stem cell transplantation for adult patients with myeloid malignancies: A multicenter retrospective study
Jieling Jiang,
Xiaofan Li,
Dong Wu,
Quanyi Lu,
Kourong Miao,
Houcai Wang,
Xiaoping Li,
Yingnian Chen,
Shiyuan Zhou,
Yali Zhou,
Guiping Liao,
Chuanhe Jiang,
Xiaohong Yuan,
Youshan Zhao,
Chunkang Chang,
Jie Chen,
Han Zhu,
Ruye Ma,
Nainong Li,
Xiaolin Yin,
Xiaojin Wu,
Sanbin Wang,
Chun Wang,
Jiong Hu
Affiliations
Jieling Jiang
Department of Hematology. Shanghai Institute of Hematology Blood & Marrow Transplantation Center Collaborative Innovation Center of Hematology Shanghai Jiao Tong University Medical School Affiliated Ruijin Hospital Shanghai China
Xiaofan Li
Department of Hematology Fujian Medical University Union Hospital Fuzhou China
Dong Wu
Department of Hematology Shanghai JiaoTong University Affiliated sixth People's Hospital Shanghai China
Quanyi Lu
Department of Hematology Zhongshan Hospital Xiamen University Xiamen China
Kourong Miao
Department of Hematology The First Affiliated Hospital of Nanjing Medical University Nanjing China
Houcai Wang
Shanghai Tenth People's Hospital Department of Hematology Tongji University School of Medicine Shanghai China
Xiaoping Li
Department of Hematology The 920th Hospital of Joint Logistics Support Force of the People's Liberation Army of China Kunming China
Yingnian Chen
Department of Hematology The 920th Hospital of Joint Logistics Support Force of the People's Liberation Army of China Kunming China
Shiyuan Zhou
Department of Hematology First Affiliated Hospital of Soochow University Suzhou China
Yali Zhou
Department of Hematology The 923rd Hospital of Joint Logistics Support Force of the People's Liberation Army of China Nanning China
Guiping Liao
Department of Hematology The 923rd Hospital of Joint Logistics Support Force of the People's Liberation Army of China Nanning China
Chuanhe Jiang
Department of Hematology. Shanghai Institute of Hematology Blood & Marrow Transplantation Center Collaborative Innovation Center of Hematology Shanghai Jiao Tong University Medical School Affiliated Ruijin Hospital Shanghai China
Xiaohong Yuan
Department of Hematology Fujian Medical University Union Hospital Fuzhou China
Youshan Zhao
Department of Hematology Shanghai JiaoTong University Affiliated sixth People's Hospital Shanghai China
Chunkang Chang
Department of Hematology Shanghai JiaoTong University Affiliated sixth People's Hospital Shanghai China
Jie Chen
Department of Hematology Zhongshan Hospital Xiamen University Xiamen China
Han Zhu
Department of Hematology The First Affiliated Hospital of Nanjing Medical University Nanjing China
Ruye Ma
Shanghai Tenth People's Hospital Department of Hematology Tongji University School of Medicine Shanghai China
Nainong Li
Department of Hematology Fujian Medical University Union Hospital Fuzhou China
Xiaolin Yin
Department of Hematology The 923rd Hospital of Joint Logistics Support Force of the People's Liberation Army of China Nanning China
Xiaojin Wu
Department of Hematology First Affiliated Hospital of Soochow University Suzhou China
Sanbin Wang
Department of Hematology The 920th Hospital of Joint Logistics Support Force of the People's Liberation Army of China Kunming China
Chun Wang
Department of Hematology Go Broad Health Center Shanghai Zhaxin Hospital Shanghai China
Jiong Hu
Department of Hematology. Shanghai Institute of Hematology Blood & Marrow Transplantation Center Collaborative Innovation Center of Hematology Shanghai Jiao Tong University Medical School Affiliated Ruijin Hospital Shanghai China
Abstract Relapse remains the main cause of treatment failure in patients with myeloid malignancies even after allogeneic hematopoietic stem cell transplantation (allo‐HSCT). We observed a particularly low incidence of relapse in patients prepared with fludarabine, busulfan and melphalan in our previous study and this multicenter retrospective analysis aimed to confirm the feasibility of the regimen and to identify the potential prognostic factors. This study was performed using registry data from adults patients with myeloid malignancies who underwent their first allo‐HSCT following fludarabine(≥100 mg/m2), busulfan (≥3.2 mg/kg) and melphalan (≥100 mg/m2) based conditioning at nine transplantation centers in China between Jan. 2020 and Mar. 2022. A total of 221 consecutive patients (AML n = 171, MDS‐IB‐1 or 2 n = 44, CMML n = 6) with median age of 46 were enrolled in this study. The median follow‐up was 507 days for survivors. The 2‐year NRM, CIR, OS and DFS were 10.6% ± 2.2%, 14.8% ± 3.3%, 79.4% ± 3.7% and 74.6% ± 3.7%, respectively. In multivariate analyses, high HCT‐CI (≥3) was the only independent factor for higher NRM [hazard ratio (HR), 2.96; 95% confidence interval (CI), 1.11 to 7.90; p = 0.030] and ECOG score ≥2 was the only independent factor for inferior OS (HR, 2.43; 95%CI, 1.15 to 5.16; p = 0.020) and DFS (HR, 2.12; 95%CI, 1.13 to 4.02; p = 0.020). AML diagnosis and positive measurable residual disease (MRD) at transplantation were predictors for higher CIR (HR = 7.92, 95%CI 1.05‐60.03, p = 0.045; HR = 3.64, 95%CI 1.40‐9.44, p = 0.008; respectively), while post‐transplantation cyclophosphamide based graft‐versus‐host disease prophylaxis was associated with lower CIR (HR = 0.24 95%CI 0.11‐0.54, p = 0.001). The intensity of conditioning regimen did not impact CIR, NRM, DFS and OS. These results supported that double alkylating agents of busulfan and melphalan based conditioning regimens were associated with low relapse rate and acceptable NRM in adult patients with myeloid malignancies. The optimal dose remained to be confirmed by further prospective studies.