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Curative potential of fludarabine, melphalan, and non-myeloablative dosage of busulfan in elderly patients with myeloid malignancy

  • Tomoaki UedaEmail author
  • Tomoyasu Jo
  • Kazuya Okada
  • Yasuyuki Arai
  • Takayuki Sato
  • Takeshi Maeda
  • Tatsuhito Onishi
  • Yasunori Ueda
Original Article
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Abstract

Although the combination of fludarabine and high-dose melphalan (FLU/MEL) has been widely used in allogeneic stem cell transplantation, high-dose MEL causes life-threatening adverse events, especially in elderly patients. To reduce the toxicity of MEL without losing its antileukemic effect, we formulated a regimen comprising FLU (125 mg/m2), MEL (100 mg/m2), and a non-myeloablative busulfan dosage [4 mg/kg orally (oral) or 3.2 mg/kg intravenously (iv); FLU/MEL/BU]. We retrospectively analyzed 32 patients with myeloid malignancies who received FLU/MEL/BU at our institute. Median age was 59 years and the median observation period after allo-SCT was 8.2 years. The disease status of most of the patients (97%) at transplantation was controlled. The rate of neutrophil engraftment was 93.3%. The 5-year overall survival (OS), disease-free survival (DFS), non-relapse mortality (NRM), and relapse rate (RR) were 68.5%, 62.1%, 22.0%, and 15.9%, respectively, in all patients. Notably, the outcome of FLU/MEL/iv BU was excellent, with the 5-year OS and DFS being 75.6% and 70.8%, respectively, accompanied by a reduced 5-year NRM and RR of 19.3% and 9.8%, respectively. In conclusion, FLU/MEL/BU, particularly FLU/MEL/iv BU, has curative potential for controlled myeloid malignancies.

Keywords

Allogeneic stem cell transplantation Conditioning regimen Myeloid malignancy Busulfan Melphalan 

Notes

Acknowledgements

This study was conducted at Kurashiki Central Hospital’s Department of Hematology/Oncology. We would like to thank all clinicians, medical staffs, and patients who contributed to this research.

Author contributions

TU and YU designed the study and analyzed the data. Transplantation was performed by TU, TJ, KO, YA, TS, TM, and TO with assistance from YU. The manuscript was written by TU and YU with assistance from TJ, KO, YA, TS, TM, and TO.

Compliance with ethical standards

Conflict of interest

The authors declare no conflict of interest.

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Copyright information

© Japanese Society of Hematology 2019

Authors and Affiliations

  • Tomoaki Ueda
    • 1
    • 2
    Email author
  • Tomoyasu Jo
    • 1
    • 3
  • Kazuya Okada
    • 1
  • Yasuyuki Arai
    • 1
    • 3
  • Takayuki Sato
    • 1
  • Takeshi Maeda
    • 1
  • Tatsuhito Onishi
    • 1
  • Yasunori Ueda
    • 1
  1. 1.Department of Hematology/OncologyKurashiki Central HospitalKurashikiJapan
  2. 2.Department of Hematology and OncologyOsaka University Graduate School of MedicineSuitaJapan
  3. 3.Department of Hematology and Oncology, Graduate School of MedicineKyoto UniversityKyotoJapan

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