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Allogeneic Haematopoietic Stem Cell Transplantation Using Reduced‐Intensity Fludarabine, Busulfan and Anti‐T‐Lymphocyte Globulin With Strategic Donor Lymphocyte Infusion in Older Patients With Myeloid Malignancy
Author(s) -
Armstrong Chris,
Conneally Eibhlin,
Flynn Catherine,
Browne Paul,
Chonghaile Mairead Ni,
Galligan Carmel Ann,
FoyStones Hayley,
Gardiner Nicola,
Lee Greg,
Orfali Nina
Publication year - 2025
Publication title -
european journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 84
eISSN - 1600-0609
pISSN - 0902-4441
DOI - 10.1111/ejh.14417
Subject(s) - medicine , busulfan , cumulative incidence , fludarabine , donor lymphocyte infusion , transplantation , cohort , regimen , hematopoietic stem cell transplantation , incidence (geometry) , myeloid , gastroenterology , immunology , cyclophosphamide , chemotherapy , physics , optics
ABSTRACT Fludarabine, busulfan, and anti‐T‐lymphocyte globulin (FLUBU3+ATLG) reduced‐intensity conditioning is an established preparative regimen for allogeneic haematopoietic stem cell transplantation in older patients with myeloid malignancy. We examined its modern‐day performance in 175 sequentially treated patients on our national programme. Overall survival was 72.4% at 2 years (95% CI 64.6%–78.6%) with a cumulative incidence of non‐relapse mortality of 11%. The cumulative 2‐year relapse incidence was 27% (95% CI 22.8%–37.6%) and was partially ameliorated by chronic graft‐versus‐host disease (HR 0.35, 95% CI 0.12–0.98, p = 0.02 ). Mixed donor chimerism was observed in 51.5% beyond day 90, but relapse was significantly reduced in these patients by adopting a pre‐emptive donor lymphocyte infusion (DLI) strategy (HR 0.22, 95% CI 0.07–0.69, p = 0.005 ). The use of DLI as part of post‐relapse salvage was also effective, with an improved median survival duration of 6 months in recipients (HR 0.43, 95% CI 0.18–0.98, p = 0.01 ). Outcomes in patients > 65 years and a limited cohort > 70 years are encouraging and compare favourably to published survival results using alternate reduced‐intensity regimens. FLUBU3+ATLG, supported by modern supportive care and a pre‐emptive DLI strategy, is well tolerated by older patients across a spectrum of myeloid disease with modest toxicity and favourable long‐term outcomes.