Fludarabine/Busulfan versus Fludarabine/Melphalan Conditioning in Patients Undergoing Reduced-Intensity Conditioning Hematopoietic Stem Cell Transplantation for Lymphoma

There is at present little data to guide the choice of conditioning for patients with lymphoma undergoing reduced-intensity conditioning (RIC) allogeneic stem cell transplantation (SCT). In this study, we compared the outcomes of patients undergoing RIC SCT who received fludarabine and melphalan (Fl...

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Autores: Kekre, N., Marquez-Malaver, Francisco J., Cabrero, Monica|||0000-0001-7586-4792, Piñana, J., Esquirol, Albert|||0000-0002-6062-5980, Soiffer, Robert J., Caballero, Dolores|||0000-0002-9544-9614, Terol, M.J., Martino Bofarull, Rodrigo|||0000-0001-5143-4042, Antin, Joseph H., Lopez-Corral, L., Solano, Carlos|||0000-0003-3702-0817, Armand, Philippe, Pérez-Simon, Jose A.
Formato: artículo
Fecha de publicación:2016
País:España
Recursos:Universitat Autònoma de Barcelona
Repositorio:Dipòsit Digital de Documents de la UAB
Idioma:inglés
OAI Identifier:oai:ddd.uab.cat:289669
Acesso em linha:https://ddd.uab.cat/record/289669
https://dx.doi.org/urn:doi:10.1016/j.bbmt.2016.07.006
Access Level:acceso abierto
Palavra-chave:Allogeneic
Busulfan
Fludarabine
Lymphoma
Melphalan
Reduced-intensity conditioning
Stem cell transplantation
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spelling Fludarabine/Busulfan versus Fludarabine/Melphalan Conditioning in Patients Undergoing Reduced-Intensity Conditioning Hematopoietic Stem Cell Transplantation for LymphomaKekre, N.Marquez-Malaver, Francisco J.Cabrero, Monica|||0000-0001-7586-4792Piñana, J.Esquirol, Albert|||0000-0002-6062-5980Soiffer, Robert J.Caballero, Dolores|||0000-0002-9544-9614Terol, M.J.Martino Bofarull, Rodrigo|||0000-0001-5143-4042Antin, Joseph H.Lopez-Corral, L.Solano, Carlos|||0000-0003-3702-0817Armand, PhilippePérez-Simon, Jose A.AllogeneicBusulfanFludarabineLymphomaMelphalanReduced-intensity conditioningStem cell transplantationThere is at present little data to guide the choice of conditioning for patients with lymphoma undergoing reduced-intensity conditioning (RIC) allogeneic stem cell transplantation (SCT). In this study, we compared the outcomes of patients undergoing RIC SCT who received fludarabine and melphalan (FluMel), the standard RIC regimen used by the Spanish Group of Transplantation, and fludarabine and busulfan (FluBu), the standard RIC regimen used by the Dana-Farber Cancer Institute/Brigham and Women's Hospital. We analyzed 136 patients undergoing RIC SCT for lymphoma with either FluBu (n = 61) or FluMel (n = 75) conditioning between 2007 and 2014. Median follow-up was 36 months. The cumulative incidence of grades II to IV acute graft-versus-host disease (GVHD) was 13% with FluBu and 36% with FluMel (P = .002). The cumulative incidence of nonrelapse mortality (NRM) at 1 year was 3.3% with FluBu and 31% with FluMel (P < .0001). The cumulative incidence of relapse at 1 year was 29% with FluBu and 10% with FluMel (P = .08). The 3-year disease-free survival rate was 47% with FluBu and 36% with FluMel (P = .24), and the 3-year overall survival rate was 62% with FluBu and 48% with FluMel (P = .01). In multivariable analysis, FluMel was associated with a higher risk of acute grades II to IV GVHD (HR, 7.45; 95% CI, 2.30 to 24.17; P = .001) and higher risk of NRM (HR, 4.87; 95% CI, 1.36 to 17.44; P = .015). The type of conditioning was not significantly associated with relapse or disease-free survival in multivariable models. However, conditioning regimen was the only factor significantly associated with overall survival: FluMel conditioning was associated with a hazard ratio for death of 2.78 (95% CI, 1.23 to 6.27; P = .014) compared with FluBu. In conclusion, the use of FluBu as conditioning for patients undergoing SCT for lymphoma was associated with a lower risk of acute GVHD and NRM and improved overall survival when compared with FluMel in our retrospective study. These results confirm the differences between these RIC regimens in terms of toxicity and efficacy and support the need for comparative prospective studies.Universitat Autònoma de Barcelona 22016-01-0120162016-01-01Articlehttp://purl.org/coar/resource_type/c_6501VoRhttp://purl.org/coar/version/c_970fb48d4fbd8a85info:eu-repo/semantics/articleapplication/pdfhttps://ddd.uab.cat/record/289669https://dx.doi.org/urn:doi:10.1016/j.bbmt.2016.07.006reponame:Dipòsit Digital de Documents de la UABinstname:Universitat Autònoma de BarcelonaInglésengopen accesshttp://purl.org/coar/access_right/c_abf2Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.https://creativecommons.org/licenses/by-nc-nd/4.0/info:eu-repo/semantics/openAccessoai:ddd.uab.cat:2896692026-06-06T12:50:31Z
dc.title.none.fl_str_mv Fludarabine/Busulfan versus Fludarabine/Melphalan Conditioning in Patients Undergoing Reduced-Intensity Conditioning Hematopoietic Stem Cell Transplantation for Lymphoma
title Fludarabine/Busulfan versus Fludarabine/Melphalan Conditioning in Patients Undergoing Reduced-Intensity Conditioning Hematopoietic Stem Cell Transplantation for Lymphoma
spellingShingle Fludarabine/Busulfan versus Fludarabine/Melphalan Conditioning in Patients Undergoing Reduced-Intensity Conditioning Hematopoietic Stem Cell Transplantation for Lymphoma
Kekre, N.
Allogeneic
Busulfan
Fludarabine
Lymphoma
Melphalan
Reduced-intensity conditioning
Stem cell transplantation
title_short Fludarabine/Busulfan versus Fludarabine/Melphalan Conditioning in Patients Undergoing Reduced-Intensity Conditioning Hematopoietic Stem Cell Transplantation for Lymphoma
title_full Fludarabine/Busulfan versus Fludarabine/Melphalan Conditioning in Patients Undergoing Reduced-Intensity Conditioning Hematopoietic Stem Cell Transplantation for Lymphoma
title_fullStr Fludarabine/Busulfan versus Fludarabine/Melphalan Conditioning in Patients Undergoing Reduced-Intensity Conditioning Hematopoietic Stem Cell Transplantation for Lymphoma
title_full_unstemmed Fludarabine/Busulfan versus Fludarabine/Melphalan Conditioning in Patients Undergoing Reduced-Intensity Conditioning Hematopoietic Stem Cell Transplantation for Lymphoma
title_sort Fludarabine/Busulfan versus Fludarabine/Melphalan Conditioning in Patients Undergoing Reduced-Intensity Conditioning Hematopoietic Stem Cell Transplantation for Lymphoma
dc.creator.none.fl_str_mv Kekre, N.
Marquez-Malaver, Francisco J.
Cabrero, Monica|||0000-0001-7586-4792
Piñana, J.
Esquirol, Albert|||0000-0002-6062-5980
Soiffer, Robert J.
Caballero, Dolores|||0000-0002-9544-9614
Terol, M.J.
Martino Bofarull, Rodrigo|||0000-0001-5143-4042
Antin, Joseph H.
Lopez-Corral, L.
Solano, Carlos|||0000-0003-3702-0817
Armand, Philippe
Pérez-Simon, Jose A.
author Kekre, N.
author_facet Kekre, N.
Marquez-Malaver, Francisco J.
Cabrero, Monica|||0000-0001-7586-4792
Piñana, J.
Esquirol, Albert|||0000-0002-6062-5980
Soiffer, Robert J.
Caballero, Dolores|||0000-0002-9544-9614
Terol, M.J.
Martino Bofarull, Rodrigo|||0000-0001-5143-4042
Antin, Joseph H.
Lopez-Corral, L.
Solano, Carlos|||0000-0003-3702-0817
Armand, Philippe
Pérez-Simon, Jose A.
author_role author
author2 Marquez-Malaver, Francisco J.
Cabrero, Monica|||0000-0001-7586-4792
Piñana, J.
Esquirol, Albert|||0000-0002-6062-5980
Soiffer, Robert J.
Caballero, Dolores|||0000-0002-9544-9614
Terol, M.J.
Martino Bofarull, Rodrigo|||0000-0001-5143-4042
Antin, Joseph H.
Lopez-Corral, L.
Solano, Carlos|||0000-0003-3702-0817
Armand, Philippe
Pérez-Simon, Jose A.
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
dc.contributor.none.fl_str_mv Universitat Autònoma de Barcelona
dc.subject.none.fl_str_mv Allogeneic
Busulfan
Fludarabine
Lymphoma
Melphalan
Reduced-intensity conditioning
Stem cell transplantation
topic Allogeneic
Busulfan
Fludarabine
Lymphoma
Melphalan
Reduced-intensity conditioning
Stem cell transplantation
description There is at present little data to guide the choice of conditioning for patients with lymphoma undergoing reduced-intensity conditioning (RIC) allogeneic stem cell transplantation (SCT). In this study, we compared the outcomes of patients undergoing RIC SCT who received fludarabine and melphalan (FluMel), the standard RIC regimen used by the Spanish Group of Transplantation, and fludarabine and busulfan (FluBu), the standard RIC regimen used by the Dana-Farber Cancer Institute/Brigham and Women's Hospital. We analyzed 136 patients undergoing RIC SCT for lymphoma with either FluBu (n = 61) or FluMel (n = 75) conditioning between 2007 and 2014. Median follow-up was 36 months. The cumulative incidence of grades II to IV acute graft-versus-host disease (GVHD) was 13% with FluBu and 36% with FluMel (P = .002). The cumulative incidence of nonrelapse mortality (NRM) at 1 year was 3.3% with FluBu and 31% with FluMel (P < .0001). The cumulative incidence of relapse at 1 year was 29% with FluBu and 10% with FluMel (P = .08). The 3-year disease-free survival rate was 47% with FluBu and 36% with FluMel (P = .24), and the 3-year overall survival rate was 62% with FluBu and 48% with FluMel (P = .01). In multivariable analysis, FluMel was associated with a higher risk of acute grades II to IV GVHD (HR, 7.45; 95% CI, 2.30 to 24.17; P = .001) and higher risk of NRM (HR, 4.87; 95% CI, 1.36 to 17.44; P = .015). The type of conditioning was not significantly associated with relapse or disease-free survival in multivariable models. However, conditioning regimen was the only factor significantly associated with overall survival: FluMel conditioning was associated with a hazard ratio for death of 2.78 (95% CI, 1.23 to 6.27; P = .014) compared with FluBu. In conclusion, the use of FluBu as conditioning for patients undergoing SCT for lymphoma was associated with a lower risk of acute GVHD and NRM and improved overall survival when compared with FluMel in our retrospective study. These results confirm the differences between these RIC regimens in terms of toxicity and efficacy and support the need for comparative prospective studies.
publishDate 2016
dc.date.none.fl_str_mv 2
2016-01-01
2016
2016-01-01
dc.type.none.fl_str_mv Article
http://purl.org/coar/resource_type/c_6501
VoR
http://purl.org/coar/version/c_970fb48d4fbd8a85
dc.type.openaire.fl_str_mv info:eu-repo/semantics/article
format article
dc.identifier.none.fl_str_mv https://ddd.uab.cat/record/289669
https://dx.doi.org/urn:doi:10.1016/j.bbmt.2016.07.006
url https://ddd.uab.cat/record/289669
https://dx.doi.org/urn:doi:10.1016/j.bbmt.2016.07.006
dc.language.none.fl_str_mv Inglés
eng
language_invalid_str_mv Inglés
language eng
dc.rights.none.fl_str_mv open access
http://purl.org/coar/access_right/c_abf2
https://creativecommons.org/licenses/by-nc-nd/4.0/
dc.rights.openaire.fl_str_mv info:eu-repo/semantics/openAccess
rights_invalid_str_mv open access
http://purl.org/coar/access_right/c_abf2
https://creativecommons.org/licenses/by-nc-nd/4.0/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.source.none.fl_str_mv reponame:Dipòsit Digital de Documents de la UAB
instname:Universitat Autònoma de Barcelona
instname_str Universitat Autònoma de Barcelona
reponame_str Dipòsit Digital de Documents de la UAB
collection Dipòsit Digital de Documents de la UAB
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