Comparison of fludarabine/melphalan (FM140) with fludarabine/melphalan/BCNU (FBM110) in patients with relapsed/refractory AML undergoing allogeneic hematopoietic cell transplantation – a registry study on behalf of the EBMT Acute Leukemia Working Par

The treatment of relapsed/refractory acute myeloid leukemia (AML) is associated with a dismal prognosis. The allogeneic hematopoietic cell transplantation (allo-HCT) is frequently performed as salvage therapy. Reduced intensity conditioning protocols have been developed with the aim of reducing the leukemia burden without increasing their toxicity. We compared the reduced intensity conditioning FM140 (fludarabine, 150 mg/m<sup>2</sup>; melphalan 140 mg/m<sup>2</sup>) with FBM110 (fludarabine 150 mg/m<sup>2</sup>; BCNU, also known as carmustine, 300-400 mg/m<sup>2</sup>; and melphalan 110 mg/m<sup>2</sup>). From the European Bone Marrow Transplantation (EBMT) Acute Leukemia Working Party registry, we identified 293 adult patients (FM140, n = 118 and FBM110, n = 175) with AML with relapsed/refractory disease prior to allo-HCT. There were some differences such as age (FM140 = 59.5 years vs. FBM110 = 65.1 years, p < 0.001) and graft-versus-host disease (GvHD) prophylaxis based on in vivo T-cell depletion (TCD, FM140 = 39% vs. FBM110 = 75%, p < 0.001). No differences were observed between FM140- and FBM110-treated patients regarding overall survival (OS) (2-year OS: 39.3% vs. 45.7%, p = 0.58), progression-free survival (PFS) (2-year PFS: 36.1% vs. 37.3%, p = 0.69), non-relapse mortality (NRM) (2-year NRM: 15.3% vs. 25.7%, p = 0.10) and relapse incidence (RI) (2-year RI: 48.6% vs. 37.0%, p = 0.7). In conclusion, despite differences in age and GvHD prophylaxis, AML patients with active disease undergoing allo-HCT after FBM110 conditioning showed similar outcomes compared to FM140.

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Publication Details

Journal
Bone Marrow Transplantation
Published
2024-12-19
DOI
https://doi.org/10.1038/s41409-024-02499-6
Citations
1
Primary Topic
Acute Myeloid Leukemia Research
Type
article
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0.45
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article

Comparison of fludarabine/melphalan (FM140) with fludarabine/melphalan/BCNU (FBM110) in patients with relapsed/refractory AML undergoing allogeneic hematopoietic cell transplantation – a registry study on behalf of the EBMT Acute Leukemia Working Par

Donald Bunjes, Jesús Duque‐Afonso, Johannes Schetelig, Pavel Jindra et al.
1 citations
Bone Marrow Transplantation
Acute Myeloid Leukemia Research
0.45
article

Comparison of fludarabine/melphalan (FM140) with fludarabine/melphalan/BCNU (FBM110) in patients with relapsed/refractory AML undergoing allogeneic hematopoietic cell transplantation – a registry study on behalf of the EBMT Acute Leukemia Working Par

Donald Bunjes, Jesús Duque‐Afonso, Johannes Schetelig, Pavel Jindra, Éolia Brissot, Wolf Rösler, Hermann Einsele, Alexandros Spyridonidis, Mohamad Mohty, Fabio Ciceri, Gerald Wulf, Matthias Eder, Eva Wagner-Drouet, Jürgen Finke, Dominik Selleslag, Maud Ngoya, Arnon Nagler, Jacques‐Emmanuel Galimard, Matthias Edinger, Gesine Bug, Andreas Neubauer, Matthias Stelljes
article en
1 citations

Abstract

The treatment of relapsed/refractory acute myeloid leukemia (AML) is associated with a dismal prognosis. The allogeneic hematopoietic cell transplantation (allo-HCT) is frequently performed as salvage therapy. Reduced intensity conditioning protocols have been developed with the aim of reducing the leukemia burden without increasing their toxicity. We compared the reduced intensity conditioning FM140 (fludarabine, 150 mg/m<sup>2</sup>; melphalan 140 mg/m<sup>2</sup>) with FBM110 (fludarabine 150 mg/m<sup>2</sup>; BCNU, also known as carmustine, 300-400 mg/m<sup>2</sup>; and melphalan 110 mg/m<sup>2</sup>). From the European Bone Marrow Transplantation (EBMT) Acute Leukemia Working Party registry, we identified 293 adult patients (FM140, n = 118 and FBM110, n = 175) with AML with relapsed/refractory disease prior to allo-HCT. There were some differences such as age (FM140 = 59.5 years vs. FBM110 = 65.1 years, p < 0.001) and graft-versus-host disease (GvHD) prophylaxis based on in vivo T-cell depletion (TCD, FM140 = 39% vs. FBM110 = 75%, p < 0.001). No differences were observed between FM140- and FBM110-treated patients regarding overall survival (OS) (2-year OS: 39.3% vs. 45.7%, p = 0.58), progression-free survival (PFS) (2-year PFS: 36.1% vs. 37.3%, p = 0.69), non-relapse mortality (NRM) (2-year NRM: 15.3% vs. 25.7%, p = 0.10) and relapse incidence (RI) (2-year RI: 48.6% vs. 37.0%, p = 0.7). In conclusion, despite differences in age and GvHD prophylaxis, AML patients with active disease undergoing allo-HCT after FBM110 conditioning showed similar outcomes compared to FM140.

Bone Marrow TransplantationVol. 60(3)
Goethe University Frankfurt (DE), Vita-Salute San Raffaele University (IT), Inserm (FR), University of Freiburg (DE), Philipps University of Marburg (DE), Johannes Gutenberg University Mainz (DE), Charles University (CZ), University of Münster (DE), Universitätsklinikum Gießen und Marburg (DE), Sheba Medical Center (IL), University Medical Center Freiburg (DE), General University Hospital of Patras (GR), Medizinische Hochschule Hannover (DE), Sorbonne Université (FR), Universitätsklinikum Erlangen (DE), University Medical Center of the Johannes Gutenberg University Mainz (DE), Assistance Publique – Hôpitaux de Paris (FR), Hôpital Saint-Antoine (FR), AZ Sint-Jan (BE), Universitätsklinikum Würzburg (DE), Centre de Recherche Saint-Antoine (FR), Istituti di Ricovero e Cura a Carattere Scientifico (IT), University Hospital Ulm (DE), University Hospital Carl Gustav Carus (DE), Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele (IT), University of Regensburg (DE), Technische Universität Dresden (DE)
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Acute Myeloid Leukemia Research
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