Yonsei Med J.  2020 Jun;61(6):452-459. 10.3349/ymj.2020.61.6.452.

Reduced-Intensity Conditioning with Busulfan and Fludarabine for Allogeneic Hematopoietic Stem Cell Transplantation in Acute Lymphoblastic Leukemia

Affiliations
  • 1Department of Hematology and Oncology, Wonkwang University Hospital, Iksan, Korea
  • 2Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, Hwasun, Korea
  • 3Department of Hematology-Oncology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
  • 4Division of Hematology-Oncology, Department of Internal Medicine, Guro Hospital, Korea University School of Medicine, Seoul, Korea
  • 5Department of Hematology-Oncology, Dong-A Medical Center, Dong-A University College of Medicine, Busan, Korea
  • 6Department of Hematology, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Korea
  • 7Department of Hematology and Oncology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
  • 8Division of Hematology-Oncology, Department of Medicine, Chung-Ang University, Seoul, Korea
  • 9Division of Hematology-Oncology, Department of Internal Medicine, Anam Hospital, Korea University School of Medicine, Seoul, Korea
  • 10Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
  • 11Department of Internal Medicine, Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju, Korea
  • 12Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
  • 13Department of Hematology and Oncology, School of Medicine, Ewha Womans University, Seoul, Korea
  • 14Department of Hematology and Oncology, Inje University Busan Paik Hospital, Busan, Korea
  • 15Department of Hematology, Catholic Hematology Hospital and Leukemia Research Institute, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea

Abstract

Purpose
Allogeneic hematopoietic stem cell transplantation (HSCT) with optimal conditioning has helped better long-term survival in acute lymphoblastic leukemia (ALL). This study investigated the efficacy and safety of reduced-intensity conditioning (RIC) with busulfan and fludarabine in adult ALL patients unfit for myeloablation.
Materials and Methods
Records of 78 patients who underwent HSCT with RIC consisting of 3.2 mg/kg/day of busulfan for 2 or 3 days and 30 mg/m2/day of fludarabine for 5 or 6 days were analyzed.
Results
The median age at diagnosis was 49 years. Over a median follow-up of 22 months, 2-year estimates of relapse-free survival (RFS) and overall survival were 57.4% and 68.7%, respectively. Multivariate analysis showed a trend of improved RFS in patients with chronic graft-versus-host disease (GVHD) (hazard ratio, 0.53; 95% confidence interval, 0.26–1.08; p=0.080). The cumulative incidences of relapse and non-relapse mortality were 42.9% and 19.6%, respectively and one case of central nervous system relapse was noted. No hepatic veno-occlusive disease was reported. Grade II–IV acute GVHD and any grade chronic GVHD occurred in 21.1% and 41.7%, respectively.
Conclusion
RIC with busulfan and fludarabine is an effective and safe conditioning regimen for adult ALL patients unfit for myeloablation.

Keyword

Fludarabine; busulfan; lymphoblastic leukemia; stem cell transplantation; transplantation conditioning
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