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

IF 4.5 2区医学 Q1 HEMATOLOGY

Bone Marrow Transplantation Pub Date : 2025-04-05 DOI:10.1038/s41409-025-02573-7

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

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引用次数: 0

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.

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用 FLU/BU4 而不是传统的 MAC 方案治疗老年急性髓性白血病患者，可改善移植后的预后。

与CY/TBI和BU/CY等传统的清髓调节（MAC）方案相比，归类为清髓调节（MAC）的FLU/BU4方案是否能改善预后尚不确定。我们比较了6551例患者（FLU/BU4 905, convo - mac 5646）的FLU/BU4和convo - mac，包括16-59岁的急性髓性白血病（AML）患者，他们接受了日本全国登记的首次同种异体移植。主要终点是总生存期（OS），次要终点是治疗相关死亡率（TRM）和3年复发率。结果显示，在整个队列中，convo - mac方案的总生存率相当(3年生存率：FLU/BU4 50.4% vs convo - mac 55.4%, p

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Bone Marrow Transplantation 医学-免疫学

CiteScore

8.40

自引率

8.30%

发文量

337

审稿时长

6 months

期刊介绍： Bone Marrow Transplantation publishes high quality, peer reviewed original research that addresses all aspects of basic biology and clinical use of haemopoietic stem cell transplantation. The broad scope of the journal thus encompasses topics such as stem cell biology, e.g., kinetics and cytokine control, transplantation immunology e.g., HLA and matching techniques, translational research, and clinical results of specific transplant protocols. Bone Marrow Transplantation publishes 24 issues a year.