Busulfan or Treosulfan Conditioning Platform for Allogeneic Stem Cell Transplantation in Patients Aged >60 Y With Acute Myeloid Leukemia/Myelodysplastic Syndrome: A Subanalysis of the GITMO AlloEld Study.
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Malagola Michele, Polverelli Nicola, Martino Massimo, Patriarca Francesca, Bruno Benedetto, Giaccone Luisa, Grillo Giovanni, Bramanti Stefania, Bernasconi Paolo, De Gobbi Marco, Natale Annalisa, Terruzzi Elisabetta, Olivieri Attilio, Chiusolo Patrizia, Carella Angelo Michele, Casini Marco, Maffini Enrico, Nozzoli Chiara, Mazza Patrizio, Bassi Simona, Onida Francesco, Vacca Adriana, Falcioni Sadia, Luppi Mario, Iori Anna Paola, Pavone Vincenzo, Skert Cristina, Carluccio Paola, Borghero Carlo, Proia Anna, Selleri Carmine, Rubini Vicky, Sacchi Nicoletta, Oldani Elena, Bonifazi Francesca, Ciceri Fabio, Russo Domenico
Аннотация
METHODS: With the aim to analyze real-life allogeneic SCTs performed in Italy between 2006 and 2017 in elderly patients (aged >60 y) with acute myeloid leukemia or myelodysplastic syndrome, we collected 780 first transplants data. For analysis purposes, patients were grouped according to the type of alkylator included in the conditioning (busulfan [BU]-based; n = 618; 79%; treosulfan [TREO]-based; n=162; 21%).
RESULTS: No significant differences were observed in nonrelapse mortality, cumulative incidence of relapse, and overall survival, although in the TREO-based group, we observed a greater proportion of elderly patients (P < 0.001); more active diseases at the time of SCT (P < 0.001); a higher prevalence of patients with either hematopoietic cell transplantation-comorbidity index ≥3 (P < 0.001) or a good Karnofsky performance status (P = 0.025); increased use of peripheral blood stem cells as graft sources (P < 0.001); and greater use of reduced intensity conditioning regimens (P = 0.013) and of haploidentical donors (P < 0.001). Moreover, the 2-y cumulative incidence of relapse with myeloablative doses of BU was significantly lower than that registered with reduced intensity conditioning (21% versus 31%; P = 0.0003). This was not observed in the TREO-based group.
CONCLUSIONS: Despite a higher number of risk factors in the TREO group, no significant differences were observed in nonrelapse mortality, cumulative incidence of relapse, and overall survival according to the type of alkylator, suggesting that TREO has no advantage over BU in terms of efficacy and toxicity in acute myeloid leukemia and myelodysplastic syndrome.