Fludarabine melphalan reduced intensity conditioning vs radiation-based myeloablative conditioning in patients undergoing allogeneic transplantation for acute myeloid leukemia with measurable residual disease
Patients with AML and measurable residual disease (MRD) undergoing allogeneic hematopoietic cell transplantation (HCT) may benefit from myeloablative conditioning (MAC) when feasible to reduce relapse risk. Fludarabine-Melphalan (FluMel) is a common reduced intensity conditioning (RIC) regimen; however, data in MRD+ patients is sparse. We performed a retrospective review of AML patients who underwent their first HCT (2016-2021) without morphologic disease at City of Hope who had pre-transplant marrow evaluated for MRD using multicolor flow cytometry (MFC) and received radiation-based MAC or FluMel conditioning. We identified 312 patients; 44 with MRD+ disease pre-HCT. The 24-month overall survival (OS), leukemia-free survival (LFS) and cumulative incidence of relapse (CIR) were 47.7%, 40.9%, and 38.6% in MRD+, and 78.0%, 73.9%, and 14.6% in MRD- patients. Radiation-based MAC was given to 136 (43.5%) patients (n = 20 with MRD+) and FluMel was given to 174 (55.8%) patients (n = 24 with MRD+). In patients with MRD+, there was no statistically significant difference between those who received MAC vs. FluMel in 24-month OS (60% vs. 38%, p = 0.21), or CIR (35% vs. 42%, p = 0.59), respectively. Our data substantiates the adverse impact of MRD in patients with AML undergoing HCT; FluMel is a reasonable option for MRD+ patients unfit for MAC.
Authors
- Yazeed Samara
- Eileen Smith (ORCID: https://orcid.org/0000-0003-2789-5046)
- Vaibhav Agrawal (ORCID: https://orcid.org/0000-0002-6383-3777)
- Vinod A. Pullarkat (ORCID: https://orcid.org/0000-0001-9129-3424)
- Sally Mokhtari
- Amanda Blackmon (ORCID: https://orcid.org/0000-0003-0732-0800)
- Jose Tinajero (ORCID: https://orcid.org/0000-0002-1175-3564)
- Ahmed Aribi (ORCID: https://orcid.org/0000-0003-2497-3176)
- Stephen J. Forman (ORCID: https://orcid.org/0000-0002-2803-4152)
- Ibrahim Taha Aldoss (ORCID: https://orcid.org/0000-0001-9564-4498)
- Guido Marcucci
- Monzr M. Al Malki (ORCID: https://orcid.org/0000-0001-8226-471X)
- Pamela S. Becker (ORCID: https://orcid.org/0000-0001-6235-9463)
- Anthony Stein
- Shukaib Arslan (ORCID: https://orcid.org/0000-0002-8447-9607)
- Andrew Artz (ORCID: https://orcid.org/0000-0003-0803-9607)
- Brian Ball (ORCID: https://orcid.org/0000-0001-8625-7023)
- Karamjeet Sandhu (ORCID: https://orcid.org/0000-0001-8024-8484)
- Amandeep Salhotra (ORCID: https://orcid.org/0000-0002-9302-5041)
- Paul Koller (ORCID: https://orcid.org/0000-0003-3830-5320)
- Haris Ali (ORCID: https://orcid.org/0000-0002-9728-7292)
- Amrita Desai
- Michelle Afkhami (ORCID: https://orcid.org/0000-0001-5830-6158)
- Hoda Pourhassan (ORCID: https://orcid.org/0000-0003-3862-4612)
- Salman Otoukesh (ORCID: https://orcid.org/0000-0002-7782-8805)
- Idoroenyi Amanam (ORCID: https://orcid.org/0000-0003-4819-4628)
- Ryotaro Nakamura (ORCID: https://orcid.org/0000-0002-9082-0680)
- Dongyun Yang (ORCID: https://orcid.org/0000-0003-0736-4977)
Institutions
- City Of Hope National Medical Center (US)
- City of Hope (US)
Publication Details
- Journal
- Bone Marrow Transplantation
- Published
- 2024-12-18
- DOI
- https://doi.org/10.1038/s41409-024-02491-0
- Primary Topic
- Acute Myeloid Leukemia Research
- Type
- article
- Field-Weighted Citation Impact
- 0.00
Funders
- National Institutes of Health
- National Cancer Institute