Efficacy and safety profile of busulfan plus low-dose melphalan (BUMEL) versus high-dose melphalan (MEL200) as a conditioning regimen for autologous hematopoietic stem cell transplantation (auto-HSCT) in multiple myeloma patients: a systematic review and meta-analysis.
Shahzaib Maqbool, Imran Khan, Muhammad Ibrahim, Aye Mon Thida, Muhamamd Salman Faisal, Fatima Faraz, Abat Khan, Moazzam Shahzad, Mohammad Ebad Ur Rehman, Qurat Ul Ain Muhammad, Abdur Rehman
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Abstract
Introduction: The optimal conditioning regimen prior to autologous stem cell transplantation (Auto-HSCT) in multiple myeloma remains uncertain. We conducted a systematic review and meta-analysis to compare the efficacy and safety of busulfan-melphalan (BUMEL) versus high-dose melphalan (HDMEL) conditioning.
Methods: A systematic literature search of PubMed, Embase, and the Cochrane Library was performed to from inception to 15 April 2025 to identify comparative studies evaluating BUMEL and HDMEL conditioning prior to Auto-HSCT. Eligible studies reported efficacy and/or safety outcomes. Risk of bias was assessed using standard methodological criteria. Pooled hazard ratios and odds ratios with 95% confidence intervals were calculated using random-effects models.
Results: Eleven studies comprising transplant-eligible patients with multiple myeloma were included. BUMEL conditioning was associated with improved progression-free survival compared with HDMEL, favoring BUMEL (HR: 0.83, 95% CI: 0.76-0.89, p < 0.00001), while no definitive overall survival benefit was observed HR: 1.10, 95% CI: 1.00-1.21, p = 0.05). BUMEL was associated with higher rates of mucositis, infections, and hepatic toxicity.
Conclusions: BUMEL conditioning offers improved disease control at the cost of increased toxicity, without a clear overall survival advantage. These findings support individualized conditioning selection, particularly in settings where upfront ASCT remains standard practice.
Registration: This protocol was registered on PROSPERO with an ID of CRD420261292372.
期刊介绍：
Advanced molecular research techniques have transformed hematology in recent years. With improved understanding of hematologic diseases, we now have the opportunity to research and evaluate new biological therapies, new drugs and drug combinations, new treatment schedules and novel approaches including stem cell transplantation. We can also expect proteomics, molecular genetics and biomarker research to facilitate new diagnostic approaches and the identification of appropriate therapies. Further advances in our knowledge regarding the formation and function of blood cells and blood-forming tissues should ensue, and it will be a major challenge for hematologists to adopt these new paradigms and develop integrated strategies to define the best possible patient care. Expert Review of Hematology (1747-4086) puts these advances in context and explores how they will translate directly into clinical practice.
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