Fludarabine-treosulfan versus fludarabine-melphalan or busulfan-cyclophosphamide conditioning in older AML or MDS patients

• Verfasst von: Beelen, Dietrich W. [VerfasserIn]
• Verfasst von: Iacobelli, Simona [VerfasserIn]
• Verfasst von: Koster, Linda [VerfasserIn]
• Verfasst von: Eikema, Dirk-Jan [VerfasserIn]
• Verfasst von: van Biezen, Anja [VerfasserIn]
• Verfasst von: Stölzel, Friedrich [VerfasserIn]
• Verfasst von: Ciceri, Fabio [VerfasserIn]
• Verfasst von: Bethge, Wolfgang Andreas [VerfasserIn]
• Verfasst von: Dreger, Peter [VerfasserIn]
• Verfasst von: Wagner-Drouet, Eva-Maria [VerfasserIn]
• Verfasst von: Reményi, Péter [VerfasserIn]
• Verfasst von: Stelljes, Matthias [VerfasserIn]
• Verfasst von: Markiewicz, Miroslaw [VerfasserIn]
• Verfasst von: McLornan, Donal [VerfasserIn]
• Verfasst von: Yakoub-Agha, Ibrahim [VerfasserIn]
• Verfasst von: Mohty, Mohamad [VerfasserIn]
• Titel: Fludarabine-treosulfan versus fludarabine-melphalan or busulfan-cyclophosphamide conditioning in older AML or MDS patients
• Titelzusatz: a clinical trial to registry data comparison
• Verf.angabe: Dietrich Wilhelm Beelen, Simona Iacobelli, Linda Koster, Dirk-Jan Eikema, Anja van Biezen, Friedrich Stölzel, Fabio Ciceri, Wolfgang Bethge, Peter Dreger, Eva-Maria Wagner-Drouet, Péter Reményi, Matthias Stelljes, Miroslaw Markiewicz, Donal P. McLornan, Ibrahim Yakoub-Agha and Mohamad Mohty
• Jahr: 2024
• Umfang: 10 S.
• Illustrationen: Diagramme
• Fussnoten: Online veröffentlicht: 21. Februar 2024 ; Gesehen am 30.10.2024
• Titel Quelle: Enthalten in: Bone marrow transplantation
• Ort Quelle: London : Springer Nature, 1997
• Jahr Quelle: 2024
• Band/Heft Quelle: 59(2024), 5, Seite 670-679
• ISSN Quelle: 1476-5365
• DOI: doi:10.1038/s41409-024-02241-2
• Datenträger: Online-Ressource
• Sprache: eng
• Sach-SW: Clinical trials
• Sach-SW: Stem-cell therapies
• K10plus-PPN: 1907200304

Abstract

A randomized study (acronym: MC-FludT.14/L Trial II) demonstrated that fludarabine plus treosulfan (30 g/m²) was an effective and well tolerated conditioning regimen for allogeneic hematopoietic cell transplantation (allo-HCT) in older patients with acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS). To further evaluate this regimen, all 252 study patients aged 50 to 70 years were compared with similar patients, who underwent allo-HCT after fludarabine/melphalan (140 mg/m²) (FluMel) or busulfan (12.8 mg/kg)/cyclophosphamide (120 mg/kg) (BuCy) regimens and whose data was provided by the European Society for Blood and Marrow Transplantation registry. In 1:1 propensity-score matched-paired analysis (PSA) of AML patients, there was no difference in 2-year-relapse-incidence after FluTreo compared with either FluMel (n = 110, p = 0.28) or BuCy (n = 78, p = 0.98). However, 2-year-non-relapse-mortality (NRM) was lower compared with FluMel (p = 0.019) and BuCy (p < 0.001). Consequently, 2-year-overall-survival (OS) after FluTreo was higher compared with FluMel (p = 0.04) and BuCy (p < 0.001). For MDS patients, no endpoint differences between FluTreo and FluMel (n = 30) were evident, whereas 2-year-OS after FluTreo was higher compared with BuCy (n = 25, p = 0.01) due to lower 2-year-NRM. Multivariate sensitivity analysis confirmed all significant results of PSA. Consequently, FluTreo (30 g/m²) seems to retain efficacy compared with FluMel and BuCy, but is better tolerated by older patients.