Premium
Thiotepa, busulfan, and cyclophosphamide as a preparative regimen for allogeneic transplantation for advanced myelodysplastic syndrome and acute myelogenous leukemia
Author(s) -
Bibawi Samer,
AbiSaid Dima,
Fayad Luis,
Anderlini Paolo,
Ueno Naoto T.,
Mehra Rakesh,
Khouri Issa,
Giralt Sergio,
Gajewski James,
Donato Michelle,
Claxton David,
Braunschweig Ira,
van Besien Koen,
Andreeff Michael,
Andersson Borje S.,
Estey Elihu H.,
Champlin Richard,
Przepiorka Donna
Publication year - 2001
Publication title -
american journal of hematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.456
H-Index - 105
eISSN - 1096-8652
pISSN - 0361-8609
DOI - 10.1002/ajh.1121
Subject(s) - busulfan , thiotepa , medicine , hazard ratio , myelodysplastic syndromes , transplantation , regimen , cyclophosphamide , gastroenterology , leukemia , surgery , oncology , hematopoietic stem cell transplantation , chemotherapy , bone marrow , confidence interval
Sixty‐two adults underwent marrow or blood stem cell transplantation from an HLA‐matched related donor using high‐dose thiotepa, busulfan, and cyclophosphamide (TBC) as the preparative regimen for treatment of advanced myelodysplastic syndrome (MDS) (refractory anemia with excess blasts with or without transformation) or acute myelogenous leukemia (AML) past first remission. All evaluable patients engrafted and had complete donor chimerism. A grade 3–4 regimen‐related toxicity occurred in eight (13%) patients, and a diagnosis of MDS was the only independent risk factor for grade 3–4 regimen‐related toxicity (hazard ratio 9.25, P = 0.01). Day‐100 treatment‐related mortality (TRM) was 19%. Poor‐prognosis cytogenetics increased the risk of day‐100 TRM (hazard ratio 11.4, P = 0.003), and use of tacrolimus for graft‐versus‐host disease prophylaxis reduced the risk of day‐100 TRM (hazard ratio 0.13, P = 0.027). For all patients, the three‐year relapse rate was 43% (95% CI, 28%–58%). Refractoriness to conventional induction chemotherapy prior to transplantation was an independent risk factor for relapse (hazard ratio 10.8, P = 0.02). Three‐year survival was 26% (95% CI, 14%–37%); survival rates were 29% for those transplanted for AML in second remission, 31% transplanted for AML in relapse, and 17% with MDS, and there were no independent risk factors for survival. TBC is an active preparative regimen for advanced AML. Patients with advanced MDS appeared to have a higher risk of toxicity and early mortality, and alternative preparative regimens should be considered for these patients. Am. J. Hematol. 67:227–233, 2001. © 2001 Wiley‐Liss, Inc.