Improved post-transplant outcomes for elderly acute myeloid leukemia patients conditioned with FLU/BU4 rather than conventional MAC regimens

It is uncertain whether FLU/BU4 regimens, classified as myeloablative conditioning (MAC), improve prognosis compared to conventional MAC regimens (conv-MAC) such as CY/TBI and BU/CY. We compared FLU/BU4 with conv-MAC among 6551 patients (FLU/BU4 905, conv-MAC 5646), including acute myeloid leukemia (AML) patients aged 16-59 who received a first allogeneic transplantation from the Japanese nationwide registry. The primary endpoint was overall survival (OS), while secondary endpoints were treatment-related mortality (TRM) and relapse at 3 years. Results indicated comparable OS for conv-MAC regimens among the entire cohort (3-year OS: FLU/BU4 50.4% vs. conv-MAC 55.4%, p < 0.001). Subgroup analysis focusing on elderly patients (aged 50-59) indicated that FLU/BU4 showed a statistically significant improvement in OS (47.0% vs. 42.8%, p = 0.036). Notably, for patients in this cohort transplanted at complete remission (CR), FLU/BU4 demonstrated a substantial advantage over conv-MAC with superior OS (HR 0.75, p = 0.046), lower TRM (HR 0.66, p = 0.035), and comparable relapse (HR 0.84, p = 0.390). These benefits were not observed in elderly patients transplanted at non-CR or in other age groups. In summary, our findings suggest that FLU/BU4 regimen, rather than conv-MAC, may be preferable in MAC-tolerant AML patients, aged 50-59 at CR status. This treatment improves survival by reducing TRM without increasing relapse risk.

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Journal
Bone Marrow Transplantation
Published
2025-04-05
DOI
https://doi.org/10.1038/s41409-025-02573-7
Primary Topic
Acute Myeloid Leukemia Research
Type
article
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article

Improved post-transplant outcomes for elderly acute myeloid leukemia patients conditioned with FLU/BU4 rather than conventional MAC regimens

Yoshinobu Kanda, Yuta Hasegawa, Masamitsu Yanada, Takuro Kuriyama et al.
Bone Marrow Transplantation
Acute Myeloid Leukemia Research
article

Improved post-transplant outcomes for elderly acute myeloid leukemia patients conditioned with FLU/BU4 rather than conventional MAC regimens

Yoshinobu Kanda, Yuta Hasegawa, Masamitsu Yanada, Takuro Kuriyama, Naoki Kurita, Noriko Doki, Nobuhiro Hiramoto, Tadakazu Kondo, Tetsuya Nishida, Takuya Shimizu, Yoshiko Atsuta, Toshiro Kawakita, Shuichi Ota, Satoshi Takahashi, Yoshimitsu Shimomura, Makoto Onizuka, Shingo Yano, Yasuyuki Arai, Takahiro Fukuda
article en

Abstract

It is uncertain whether FLU/BU4 regimens, classified as myeloablative conditioning (MAC), improve prognosis compared to conventional MAC regimens (conv-MAC) such as CY/TBI and BU/CY. We compared FLU/BU4 with conv-MAC among 6551 patients (FLU/BU4 905, conv-MAC 5646), including acute myeloid leukemia (AML) patients aged 16-59 who received a first allogeneic transplantation from the Japanese nationwide registry. The primary endpoint was overall survival (OS), while secondary endpoints were treatment-related mortality (TRM) and relapse at 3 years. Results indicated comparable OS for conv-MAC regimens among the entire cohort (3-year OS: FLU/BU4 50.4% vs. conv-MAC 55.4%, p < 0.001). Subgroup analysis focusing on elderly patients (aged 50-59) indicated that FLU/BU4 showed a statistically significant improvement in OS (47.0% vs. 42.8%, p = 0.036). Notably, for patients in this cohort transplanted at complete remission (CR), FLU/BU4 demonstrated a substantial advantage over conv-MAC with superior OS (HR 0.75, p = 0.046), lower TRM (HR 0.66, p = 0.035), and comparable relapse (HR 0.84, p = 0.390). These benefits were not observed in elderly patients transplanted at non-CR or in other age groups. In summary, our findings suggest that FLU/BU4 regimen, rather than conv-MAC, may be preferable in MAC-tolerant AML patients, aged 50-59 at CR status. This treatment improves survival by reducing TRM without increasing relapse risk.

Bone Marrow TransplantationVol. 60(6)
Jikei University School of Medicine (JP), Tokai University (JP), Jichi Medical University (JP), Aichi Medical University (JP), Tokyo Metropolitan Komagome Hospital (JP), Nagoya City University (JP), Hamanomachi Hospital (JP), Sapporo Hokuyu Hospital (JP), University of Tsukuba Hospital (JP), Japanese Red Cross Nagoya Daiichi Hospital (JP), Hokkaido University Hospital (JP), Kyoto University Hospital (JP), The Japanese Data Center for Hematopoietic Cell Transplantation (JP), Kobe City Medical Center General Hospital (JP), Kumamoto Medical Center (JP), Jichi Medical University Saitama Medical Center (JP), The University of Tokyo (JP)
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