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Myeloablative conditioning regimens for AML allografts: 30 years later
V Gupta1, H M Lazarus, A Keating
1Department of Medical Oncology and Hematology, Princess Margaret Hospital/Ontario Cancer Institute, Room 5-224, 610 University Avenue, Toronto, Ontario, Canada M5G 2M9. vikas.gupta@uhn.on.ca
Bone Marrow Transplantation
|November 5, 2003
Summary
High-dose busulfan/cyclophosphamide (BuCy) and cyclophosphamide/total body irradiation (CyTBI) are common AML allograft conditioning regimens. Survival rates are similar, but CyTBI may reduce relapse risk while BuCy increases veno-occlusive disease risk.
Area of Science:
- Hematology
- Oncology
- Stem Cell Transplantation
Background:
- Myeloablative conditioning regimens are crucial for allogeneic stem cell transplantation in acute myeloid leukemia (AML).
- Busulfan combined with cyclophosphamide (BuCy) and cyclophosphamide in combination with total body irradiation (CyTBI) are the most frequently utilized conditioning regimens.
- A systematic review of available data is needed to compare their efficacy and safety.
Purpose of the Study:
- To systematically review and compare the outcomes of myeloablative conditioning regimens used for AML allografts.
- To evaluate survival rates, relapse rates, treatment-related mortality, and incidence of veno-occlusive disease for BuCy and CyTBI regimens.
Main Methods:
- Systematic examination of data from studies reporting on myeloablative conditioning regimens for AML allografts.
- Comparative analysis of survival, relapse, treatment-related mortality, and veno-occlusive disease incidence between BuCy and CyTBI regimens.
Main Results:
- No significant differences in survival were observed between BuCy and CyTBI regimens.
- Cyclophosphamide/total body irradiation (CyTBI) showed a trend towards a decreased relapse rate, but with a nonsignificant increase in treatment-related mortality.
- Veno-occlusive disease occurred significantly more frequently in patients treated with the busulfan/cyclophosphamide (BuCy) regimen.
Conclusions:
- Both BuCy and CyTBI are viable myeloablative conditioning regimens for AML allografts, with comparable survival outcomes.
- The choice between BuCy and CyTBI may depend on institutional factors like availability and expertise, considering the trade-offs in relapse risk and toxicity.
- Further research into modified regimens and therapeutic monitoring of busulfan is warranted to optimize outcomes.