TY - JOUR
T1 - Association between the choice of the conditioning regimen and outcomes of allogeneic hematopoietic cell transplantation for myelofibrosis
AU - Murthy, Guru Subramanian Guru
AU - Kim, Soyoung
AU - Estrada-Merly, Noel
AU - Abid, Muhammad Bilal
AU - Aljurf, Mahmoud
AU - Assal, Amer
AU - Badar, Talha
AU - Badawy, Sherif M.
AU - Ballen, Karen
AU - Beitinjaneh, Amer
AU - Cerny, Jan
AU - Chhabra, Saurabh
AU - DeFilipp, Zachariah
AU - Dholaria, Bhagirathbhai
AU - Perez, Miguel Angel Diaz
AU - Farhan, Shatha
AU - Freytes, Cesar O.
AU - Gale, Robert Peter
AU - Ganguly, Siddhartha
AU - Gupta, Vikas
AU - Grunwald, Michael R.
AU - Hamad, Nada
AU - Hildebrandt, Gerhard C.
AU - Inamoto, Yoshihiro
AU - Jain, Tania
AU - Jamy, Omer
AU - Juckett, Mark
AU - Kalaycio, Matt
AU - Krem, Maxwell M.
AU - Lazarus, Hillard M.
AU - Litzow, Mark
AU - Munker, Reinhold
AU - Murthy, Hemant S.
AU - Nathan, Sunita
AU - Nishihori, Taiga
AU - Ortí, Guillermo
AU - Patel, Sagar S.
AU - van der Poel, Marjolein
AU - Rizzieri, David A.
AU - Savani, Bipin N.
AU - Seo, Sachiko
AU - Solh, Melhem
AU - Verdonck, Leo F.
AU - Wirk, Baldeep
AU - Yared, Jean A.
AU - Nakamura, Ryotaro
AU - Oran, Betul
AU - Scott, Bart
AU - Saber, Wael
N1 - Publisher Copyright:
© 2023 Ferrata Storti Foundation. All rights reserved.
PY - 2023/7/1
Y1 - 2023/7/1
N2 - Allogeneic hematopoietic cell transplantation (allo-HCT) remains the only curative treatment for myelofibrosis. However, theoptimal conditioning regimen either with reduced-intensity conditioning (RIC) or myeloablative conditioning (MAC) is not wellknown. Using the Center for International Blood and Marrow Transplant Research database, we identified adults aged =18years with myelofibrosis undergoing allo-HCT between 2008-2019 and analyzed the outcomes separately in the RIC and MACcohorts based on the conditioning regimens used. Among 872 eligible patients, 493 underwent allo-HCT using RIC (fludarabine/busulfan n=166, fludarabine/melphalan n=327) and 379 using MAC (fludarabine/busulfan n=247, busulfan/cyclophosphamide n=132). In multivariable analysis with RIC, fludarabine/melphalan was associated with inferior overall survival (hazardratio [HR]=1.80; 95% confidenec interval [CI]: 1.15-2.81; P=0.009), higher early non-relapse mortality (HR=1.81; 95% CI: 1.12-2.91;P=0.01) and higher acute graft-versus-host disease (GvHD) (grade 2-4 HR=1.45; 95% CI: 1.03-2.03; P=0.03; grade 3-4 HR=2.21;95%CI: 1.28-3.83; P=0.004) compared to fludarabine/busulfan. In the MAC setting, busulfan/cyclophosphamide was associatedwith a higher acute GvHD (grade 2-4 HR=2.33; 95% CI: 1.67-3.25; P<0.001; grade 3-4 HR=2.31; 95% CI: 1.52-3.52; P<0.001) andinferior GvHD-free relapse-free survival (GRFS) (HR=1.94; 95% CI: 1.49-2.53; P<0.001) as compared to fludarabine/busulfan.Hence, our study suggests that fludarabine/busulfan is associated with better outcomes in RIC (better overall survival, lowerearly non-relapse mortality, lower acute GvHD) and MAC (lower acute GvHD and better GRFS) in myelofibrosis.
AB - Allogeneic hematopoietic cell transplantation (allo-HCT) remains the only curative treatment for myelofibrosis. However, theoptimal conditioning regimen either with reduced-intensity conditioning (RIC) or myeloablative conditioning (MAC) is not wellknown. Using the Center for International Blood and Marrow Transplant Research database, we identified adults aged =18years with myelofibrosis undergoing allo-HCT between 2008-2019 and analyzed the outcomes separately in the RIC and MACcohorts based on the conditioning regimens used. Among 872 eligible patients, 493 underwent allo-HCT using RIC (fludarabine/busulfan n=166, fludarabine/melphalan n=327) and 379 using MAC (fludarabine/busulfan n=247, busulfan/cyclophosphamide n=132). In multivariable analysis with RIC, fludarabine/melphalan was associated with inferior overall survival (hazardratio [HR]=1.80; 95% confidenec interval [CI]: 1.15-2.81; P=0.009), higher early non-relapse mortality (HR=1.81; 95% CI: 1.12-2.91;P=0.01) and higher acute graft-versus-host disease (GvHD) (grade 2-4 HR=1.45; 95% CI: 1.03-2.03; P=0.03; grade 3-4 HR=2.21;95%CI: 1.28-3.83; P=0.004) compared to fludarabine/busulfan. In the MAC setting, busulfan/cyclophosphamide was associatedwith a higher acute GvHD (grade 2-4 HR=2.33; 95% CI: 1.67-3.25; P<0.001; grade 3-4 HR=2.31; 95% CI: 1.52-3.52; P<0.001) andinferior GvHD-free relapse-free survival (GRFS) (HR=1.94; 95% CI: 1.49-2.53; P<0.001) as compared to fludarabine/busulfan.Hence, our study suggests that fludarabine/busulfan is associated with better outcomes in RIC (better overall survival, lowerearly non-relapse mortality, lower acute GvHD) and MAC (lower acute GvHD and better GRFS) in myelofibrosis.
KW - Adult
KW - Humans
KW - Adolescent
KW - Primary Myelofibrosis/diagnosis
KW - Busulfan/therapeutic use
KW - Melphalan
KW - Retrospective Studies
KW - Hematopoietic Stem Cell Transplantation/adverse effects
KW - Cyclophosphamide/therapeutic use
KW - Graft vs Host Disease/etiology
KW - Transplantation Conditioning
KW - Vidarabine/therapeutic use
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U2 - 10.3324/haematol.2022.281958
DO - 10.3324/haematol.2022.281958
M3 - Article
C2 - 36779595
AN - SCOPUS:85152676494
SN - 0390-6078
VL - 108
SP - 1900
EP - 1908
JO - Haematologica
JF - Haematologica
IS - 7
ER -