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Busulfan and melphalan as conditioning regimen for allogeneic hematopoietic stem cell transplantation in acute myeloid leukemia in first complete remission

DOI: 10.5581/1516-8484.20110050

Keywords: stem cell transplantation, leukemia, myeloid, acute, drug toxicity, bone marrow transplantation, busulfan [administration & dosage], combined modality therapy, cyclophosphamide [administration & dosage], graft vs. host disease, survival analysis, prognosis.

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Abstract:

background: allogeneic hematopoietic stem cell transplantation with hla-identical donors has been established for the treatment of acute myeloid leukemia patients for over 30 years with a cure rate of 50% to 60%. objectives: to analyze the overall survival of patients and identify factors that influence the outcomes of this type of transplant in patients in 1st complete remission who received a busulfan and melphalan combination as conditioning regimen. methods: twenty-five consecutive patients with acute myeloid leukemia were enrolled between 2003 and 2008. the median age was 34 years old (range: 16 - 57 years). all patients received cyclosporine and methotrexate for prophylaxis against graft-versus-host disease. median neutrophil engraftment time was 16 days (range: 7 - 22 days) and 17 days (range: 7 - 46 days) for platelets. sinusoidal obstructive syndrome was observed in three patients, seven had grade ii acute graft-versus-host disease and one extensive chronic graft-versus-host disease. results: the overall survival by the kaplan-meier method was 48% after 36 months with a plateau at 36 months after transplantation. intensive consolidation with high-dose arabinoside resulted in an improved survival (p-value = 0.0001), as did grade ii acute graft-versus-host disease (p-value = 0.0377) and mild chronic graft-versus-host disease (p-value < 0.0001). thirteen patients died, five due to infection within 100 days of transplant, two due to hemorrhages, one to infection and graftversus-host disease and three relapses followed by renal failure (one) and infection (two). the cause of death could not be determined for two patients. conclusion: the busulfan and melphalan conditioning regimen is as good as other conditioning regimens providing an excellent survival rate.

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