Augmented FLAMSA-Bu versus FluBu2 reduced-intensity conditioning in patients with active relapsed/refractory acute myeloid leukemia: an EBMT analysis

Rodriguez-Arboli E, Labopin M, Eder M, Brecht A, Blau IW, Huynh A, Forcade E, Tischer J, Bethge W, Bondarenko S, Verbeek M, Bulabois CE, Einsele H, Stolzel F, Savani B, Spyridonidis A, Bazarbachi A, Giebel S, Brissot E, Schmid C, Nagler A, Mohty M (2022)

Publication Type: Journal article

Publication year: 2022

Journal

Book Volume: 57

Pages Range: 934-941

Journal Issue: 6

DOI: 10.1038/s41409-022-01611-y

Abstract

Comparative data of fludarabine, cytarabine and amsacrine (FLAMSA) chemotherapy followed by busulfan (Bu)-based reduced-intensity conditioning (RIC) (FLAMSA-Bu) versus RIC regimens are lacking in patients with active relapsed/refractory (R/R) acute myeloid leukemia (AML) at the time of allogeneic hematopoietic stem cell transplantation (alloSCT). Here, we retrospectively analyzed outcomes after FLAMSA-Bu versus fludarabine/busulfan (FluBu2) conditioning in this patient population. A total of 476 patients fulfilled the inclusion criteria, of whom 257 received FluBu2 and 219 FLAMSA-Bu. Median follow-up was 41 months. Two-year non-relapse mortality (21%), graft-versus-host disease-free, relapse-free survival (24%) and chronic graft-versus-host disease (GVHD) (29%) were not statistically different between cohorts. FLAMSA-Bu was associated with lower 2-year relapse incidence (RI) (38 vs 49% after FluBu2, p = 0.004), and increased leukemia-free survival (LFS) (42 vs 29%, p = 0.001), overall survival (47 vs 39%, p = 0.008) and grades II-IV acute GVHD (36 vs 20%, p = 0.001). In the multivariate analysis, FLAMSA-Bu remained associated with lower RI (HR 0.69, p = 0.042), increased LFS (HR 0.74, p = 0.048) and a higher risk of acute GVHD (HR 2.06, p = 0.005). Notwithstanding the limitations inherent in this analysis, our data indicate that FLAMSA-Bu constitutes a tolerable conditioning strategy, resulting in a long-term benefit in a subset of patients reaching alloSCT with active disease.

Involved external institutions

University of Seville / Universidad de Sevilla Spain (ES) University of Paris 4 - Paris-Sorbonne / Université paris IV Paris-Sorbonne France (FR) Medizinische Hochschule Hannover (MHH) / Hannover Medical School Germany (DE) Deutsche Klinik für Diagnostik (DKD) Germany (DE) Charité - Universitätsmedizin Berlin Germany (DE) Toulouse Oncopole Cancer University Institute (IUCT-O) / Institut universitaire du cancer de Toulouse Oncopole (IUCT-O) France (FR) Centre Hospitalier Universitaire de Bordeaux / CHU Bordeaux France (FR) Ludwig-Maximilians-Universität (LMU) Germany (DE) Universitätsklinikum Tübingen Germany (DE) First Pavlov State Medical University of St. Petersburg Russian Federation (RU) Klinikum rechts der Isar Germany (DE) University of Grenoble Alpes (UGA) / Université de Grenoble France (FR) Universitätsklinikum Würzburg Germany (DE) Technische Universität Dresden Germany (DE) Vanderbilt University United States (USA) (US) Universitätsklinikum Patras Greece (GR) American University of Beirut (AUB) / الجامعة الأميركية في بيروت‎‎ Lebanon (LB) Maria Skłodowska-Curie Institute of Oncology / Centrum Onkologii–Instytut im. Marii Skłodowskiej-Curie w Warszawie Poland (PL) Universitätsklinikum Augsburg Germany (DE) Chaim Sheba Medical Center at Tel HaShomer / המרכז הרפואי עש חיים שיבא – תל השומר‎‎ Israel (IL)

How to cite

APA:

Rodriguez-Arboli, E., Labopin, M., Eder, M., Brecht, A., Blau, I.W., Huynh, A.,... Mohty, M. (2022). Augmented FLAMSA-Bu versus FluBu2 reduced-intensity conditioning in patients with active relapsed/refractory acute myeloid leukemia: an EBMT analysis. Bone Marrow Transplantation, 57(6), 934-941. https://doi.org/10.1038/s41409-022-01611-y

MLA:

Rodriguez-Arboli, Eduardo, et al. "Augmented FLAMSA-Bu versus FluBu2 reduced-intensity conditioning in patients with active relapsed/refractory acute myeloid leukemia: an EBMT analysis." Bone Marrow Transplantation 57.6 (2022): 934-941.

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