Transplantation Direct (Mar 2023)
Busulfan or Treosulfan Conditioning Platform for Allogeneic Stem Cell Transplantation in Patients Aged >60 Y With Acute Myeloid Leukemia/Myelodysplastic Syndrome: A Subanalysis of the GITMO AlloEld Study
- Michele Malagola, MD,
- Nicola Polverelli, MD,
- Massimo Martino, MD,
- Francesca Patriarca, MD,
- Benedetto Bruno, MD,
- Luisa Giaccone, MD,
- Giovanni Grillo, MD,
- Stefania Bramanti, MD,
- Paolo Bernasconi, MD,
- Marco De Gobbi, MD,
- Annalisa Natale, MD,
- Elisabetta Terruzzi, MD,
- Attilio Olivieri, MD,
- Patrizia Chiusolo, MD,
- Angelo Michele Carella, MD,
- Marco Casini, MD,
- Enrico Maffini, MD,
- Chiara Nozzoli, MD,
- Patrizio Mazza, MD,
- Simona Bassi,
- Francesco Onida, MD,
- Adriana Vacca, MD,
- Sadia Falcioni, MD,
- Mario Luppi, MD,
- Anna Paola Iori, MD,
- Vincenzo Pavone, MD,
- Cristina Skert, MD,
- Paola Carluccio, MD,
- Carlo Borghero, MD,
- Anna Proia, MD,
- Carmine Selleri, MD,
- Vicky Rubini, MD,
- Nicoletta Sacchi, MD,
- Elena Oldani, MD,
- Francesca Bonifazi, MD,
- Fabio Ciceri, MD,
- Domenico Russo, MD,
- Simona Bernardi,
- Mirko Farina,
- Maria Fiore,
- Maria Teresa Lupo Stanghellini,
- Renato Fanin,
- Danilo Giuseppe Faraci,
- Luca Castagna,
- Anna Amelia Colombo,
- Paolo Nicoli,
- Stella Santarone,
- Ilaria Scortechini,
- Elisabetta Metafuni,
- Emanuela Merla,
- Irene Cavattoni,
- Ilaria Cutini,
- Annamaria Mazzone,
- Giorgia Saporiti,
- Filippo Antonio Canale,
- Eugenia Piras,
- Piero Galieni,
- Giulia Debbia,
- Ursula La Rocca,
- Anna Mele,
- Francesca Carobolante,
- Francesca Elice,
- Fulvia Fanelli
Affiliations
- Michele Malagola, MD
- 1 Department of Clinical and Experimental Sciences, Blood Diseases and Cell Therapies Unit, Bone Marrow Transplant Unit, “Azienda Socio Santiaria Territoriale Spedali Civili” Hospital of Brescia, University of Brescia, Brescia, Italy.
- Nicola Polverelli, MD
- 1 Department of Clinical and Experimental Sciences, Blood Diseases and Cell Therapies Unit, Bone Marrow Transplant Unit, “Azienda Socio Santiaria Territoriale Spedali Civili” Hospital of Brescia, University of Brescia, Brescia, Italy.
- Massimo Martino, MD
- 2 Stem Cell Transplant and Cellular Therapies Unit, “Bianco Melacrino Morelli” Hospital, Reggio Calabria, Italy.
- Francesca Patriarca, MD
- 3 Haematological Clinic and Transplant Centre, University Hospital of Central Friuli, Dipartimento Area Medica, University of Udine, Udine, Italy.
- Benedetto Bruno, MD
- 4 Department of Oncology, Struttura Semplice Dipartimentale Allogeneic Stem Cell Transplantation, “Città della Salute e della Scienza” University Hospital Centre in Turin, Turin, Italy.
- Luisa Giaccone, MD
- 4 Department of Oncology, Struttura Semplice Dipartimentale Allogeneic Stem Cell Transplantation, “Città della Salute e della Scienza” University Hospital Centre in Turin, Turin, Italy.
- Giovanni Grillo, MD
- 6 Division of Haematology and Marrow Transplants, Niguarda Hospital, Milan, Italy.
- Stefania Bramanti, MD
- 7 Istituto di Ricerca e Cura a Carattere Scientifico Humanitas Research Hospital, Rozzano, Milan, Italy.
- Paolo Bernasconi, MD
- 8 Transplant Centre, Unit of Haematology Foundation Istituto di Ricerca e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy.
- Marco De Gobbi, MD
- 9 Department of Clinical and Biological Sciences, University of Turin, Turin, Italy.
- Annalisa Natale, MD
- 11 Haematological Intensive Care, Pescara Hospital, Pescara, Italy.
- Elisabetta Terruzzi, MD
- 12 Haematology Unit, San Gerardo Hospital, Monza, Italy.
- Attilio Olivieri, MD
- 13 Haematology Clinc, “Ospedali Riuniti” University Hospital of Ancona, Ancona, Italy.
- Patrizia Chiusolo, MD
- 14 Department of Medical Imaging, Radiotherapy, Oncology and Haematology, “A. Gemelli Istituto di Ricerca e Cura a Carattere Scientifico” University Teaching Hospital Foundation, Rome, Italy.
- Angelo Michele Carella, MD
- 16 Struttura Semplice Dipartimentale Haematological Intensive Care and Cell Therapy Unit, Department of Medical Sciences, “Casa Sollievo della Sofferenza” Foundation, San Giovanni Rotondo, Italy.
- Marco Casini, MD
- 17 Haematology and Bone Marrow Transplantation, Bolzano Hospital, Bolzano, Italy.
- Enrico Maffini, MD
- 18 Istituto di Ricerca e Cura a Carattere Scientifico Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
- Chiara Nozzoli, MD
- 19 Cell Therapy and Transfusion Medicine, “Careggi” University Hospital, Florence, Italy.
- Patrizio Mazza, MD
- 20 PO San Giuseppe Moscati, Transplant Division, Department of Haematology, ASL Taranto, Italy.
- Simona Bassi
- 21 Haematology Unit, “G. da Saliceto” Hospital, Piacenza, Italy.
- Francesco Onida, MD
- 22 Istituto di Ricerca e Cura a Carattere Scientifico Foundation “Ospedale Maggiore Ca’ Granda Policlinico,” University of Milan, Italy.
- Adriana Vacca, MD
- 23 Hematology Unit, Centro Trapianti di Midollo Osseo P.O. “ A. Businco”, ARNAS Brotzu, Cagliari, Italy.
- Sadia Falcioni, MD
- 24 Unit of Haematology and Cell Therapy, “C. e G. Mazzoni” Hospital, Ascoli Piceno, Italy.
- Mario Luppi, MD
- 25 Division of Hematology Azienda Ospedaliero-Universitaria Modena, Department of Medical and Surgical Sciences, Università degli Studi di Modena e Reggio Emilia, Modena, Italy.
- Anna Paola Iori, MD
- 26 Department of Haematology, Oncology and Dermatology, “Umberto I” University Hospital, Roma Sapienza University, Rome, Italy.
- Vincenzo Pavone, MD
- 27 Department of Haematology and Bone Marrow Transplantation, “Card. G. Panico” Hospital, Tricase, Italy.
- Cristina Skert, MD
- 28 Unit of Haematology/Bone Marrow Transplantation, Unit “Ospedale dell’Angelo”, Venice, Mestre, Italy.
- Paola Carluccio, MD
- 29 Department of Emergency and Organ Transplantation, Haematology and Stem Cell Transplantation Unit, “Aldo Moro” University of Bari, Bari, Italy.
- Carlo Borghero, MD
- 30 Haematology Department, “San Bortolo” Hospital, Vicenza, Italy.
- Anna Proia, MD
- 31 Unit of Haematology and Stem Cell Transplant Centre, “San Camillo” Hospital, Rome, Italy.
- Carmine Selleri, MD
- 32 “San Giovanni di Dio e Ruggi d’Aragona” University Hospital, Salerno, Italy.
- Vicky Rubini, MD
- 33 University of Milan, Italy.
- Nicoletta Sacchi, MD
- 34 Italian Bone Marrow Donor Registry, E.O. Galliera Hospitals, Genoa, Italy.
- Elena Oldani, MD
- 35 Haematology Unit, “Azienda Socio Santiaria Territoriale Papa Giovanni XXIII”, Bergamo, Italy.
- Francesca Bonifazi, MD
- 18 Istituto di Ricerca e Cura a Carattere Scientifico Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
- Fabio Ciceri, MD
- 36 Department of Onco-Haematology, Haematology and Bone Marrow Transplantation, Istituto di Ricerca e Cura a Carattere Scientifico San Raffaele Scientific Institute and Vita-Salute San Raffaele University, Milan, Italy.
- Domenico Russo, MD
- 1 Department of Clinical and Experimental Sciences, Blood Diseases and Cell Therapies Unit, Bone Marrow Transplant Unit, “Azienda Socio Santiaria Territoriale Spedali Civili” Hospital of Brescia, University of Brescia, Brescia, Italy.
- Simona Bernardi
- Mirko Farina
- Maria Fiore
- Maria Teresa Lupo Stanghellini
- Renato Fanin
- Danilo Giuseppe Faraci
- Luca Castagna
- Anna Amelia Colombo
- Paolo Nicoli
- Stella Santarone
- Ilaria Scortechini
- Elisabetta Metafuni
- Emanuela Merla
- Irene Cavattoni
- Ilaria Cutini
- Annamaria Mazzone
- Giorgia Saporiti
- Filippo Antonio Canale
- Eugenia Piras
- Piero Galieni
- Giulia Debbia
- Ursula La Rocca
- Anna Mele
- Francesca Carobolante
- Francesca Elice
- Fulvia Fanelli
- DOI
- https://doi.org/10.1097/TXD.0000000000001451
- Journal volume & issue
-
Vol. 9,
no. 3
p. e1451
Abstract
Background. The conditioning regimens with different alkylators at different doses can influence the outcome of allogeneic stem cell transplantation (SCT), but conclusive data are missing. Methods. With the aim to analyze real-life allogeneic SCTs performed in Italy between 2006 and 2017 in elderly patients (aged >60 y) with acute myeloid leukemia or myelodysplastic syndrome, we collected 780 first transplants data. For analysis purposes, patients were grouped according to the type of alkylator included in the conditioning (busulfan [BU]-based; n = 618; 79%; treosulfan [TREO]-based; n=162; 21%). Results. No significant differences were observed in nonrelapse mortality, cumulative incidence of relapse, and overall survival, although in the TREO-based group, we observed a greater proportion of elderly patients (P < 0.001); more active diseases at the time of SCT (P < 0.001); a higher prevalence of patients with either hematopoietic cell transplantation-comorbidity index ≥3 (P < 0.001) or a good Karnofsky performance status (P = 0.025); increased use of peripheral blood stem cells as graft sources (P < 0.001); and greater use of reduced intensity conditioning regimens (P = 0.013) and of haploidentical donors (P < 0.001). Moreover, the 2-y cumulative incidence of relapse with myeloablative doses of BU was significantly lower than that registered with reduced intensity conditioning (21% versus 31%; P = 0.0003). This was not observed in the TREO-based group. Conclusions. Despite a higher number of risk factors in the TREO group, no significant differences were observed in nonrelapse mortality, cumulative incidence of relapse, and overall survival according to the type of alkylator, suggesting that TREO has no advantage over BU in terms of efficacy and toxicity in acute myeloid leukemia and myelodysplastic syndrome.
