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Comparison of melphalan‐ And busulfan‐based myeloablative conditioning in children undergoing allogeneic transplantation for acute myeloid leukemia or myelodysplasia
Author(s) -
Oshrine Benjamin,
Adams Lauren,
Nguyen Anh Thy H.,
Amankwah Ernest,
Shyr David,
Hale Gregory,
Petrovic Aleksandra
Publication year - 2020
Publication title -
pediatric transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.457
H-Index - 69
eISSN - 1399-3046
pISSN - 1397-3142
DOI - 10.1111/petr.13672
Subject(s) - busulfan , medicine , surgery , transplantation , melphalan , regimen , myeloid leukemia , gastroenterology , cumulative incidence , hematopoietic stem cell transplantation
Abstract Background The optimal conditioning regimen for alloHCT in children with myeloid malignancies remains undefined. Procedure We performed a retrospective review of children undergoing alloHCT for AML and MDS over a 10‐year period (2008‐2018) at our institution, comparing the outcomes of recipients of either a myeloablative busulfan‐ or reduced toxicity mel/thio‐based conditioning regimen. Results A total of 49 patients underwent alloHCT for AML/MDS (mel/thio, N = 21; busulfan, N = 28). Mel/thio recipients were selected due to pretransplant comorbidities. Recipients of mel/thio were more likely to have t‐AML, and less likely to have MRD <0.1% at the time of alloHCT (57.1% vs 82.1%). Graft failure was more common in busulfan recipients; engraftment kinetics were similar between groups. Sinusoidal obstructive syndrome was diagnosed in 21% of busulfan and no mel/thio recipients ( P = .03). One patient in each group died from TRM. Relapse incidence was comparable (mel/thio—29% vs busulfan—32%); however, relapse occurred significantly later in recipients of mel/thio conditioning (median d + 396 vs d + 137; P = .01). As a result, there was a trend toward improved OS at 1 and 3 years in mel/thio recipients (95% vs 74%, P = .06; and 75% vs 50%, P = .11; respectively). Conclusion In our single institution, when compared to myeloablative busulfan‐based conditioning, use of a mel/thio‐based reduced toxicity regimen resulted in comparable outcomes, despite higher risk patient and disease characteristics. Mel/thio recipients had both more comorbidities and higher risk disease profile, which did not translate into higher rates of either TRM or relapse.