Long-Term Results of Busulfan Plus High-Dose Idarubicin as a Conditioning Regimen to Autologous Stem Cell Transplantation Following Cytarabine Consolidation in Young Patients with Favorable or Intermediate-Risk Acute Myeloid Leukemia.
Zixing Lu, Yayi Liu, Zhaoqing Jiang, Yu Zhu, Wenjie Liu, Qian Sun, Lei Fan, Sixuan Qian, Ming Hong
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引用次数: 0
Abstract
Objective: To evaluate the long-term efficacy and safety of high-dose idarubicin plus busulfan (I-Bu) conditioning followed by autologous stem cell transplantation (ASCT) compared to intermediate- to high-dose cytarabine (Ara-C) consolidation in young acute myeloid leukemia (AML) patients with favorable- or intermediate-risk in first complete remission (CR1).
Methods: We retrospectively analyzed clinical data from 59 young AML patients (aged ≤ 65 years) with favorable- or intermediate-risk disease who received the I-Bu conditioning regimen followed by ASCT between December 2004 and December 2021 (ASCT group). Clinical outcomes were compared with 57 favorable- and intermediate-risk AML patients treated with intermediate- to high-dose Ara-C consolidation chemotherapy alone (chemotherapy group). Overall survival (OS) and disease-free survival (DFS) were evaluated, and univariate and multivariate analyses were performed to identify prognostic factors associated with OS.
Results: A total of 116 patients were included with a median follow-up of 79.5 months. Median OS was not reached in either group. The ASCT group achieved a significantly higher 2-year OS rate (84.5% vs 59.7%, P=0.0018) and sustained a significant OS benefit in the 10-year OS rate (P=0.0017). DFS rate also showed superiority in the ASCT group at 2-year (77.7% vs 53.5%, P=0.0037) and maintained this benefit in the 10-year DFS rate (P=0.0038). Multivariate Cox regression identified treatment modality as an independent prognostic factor for OS (HR = 3.12, 95% CI: 1.48-6.59, P=0.0028). In subgroup analysis, ASCT significantly improved OS (P<0.001) and DFS (P=0.0014) in favorable-risk patients, whereas no differences were observed in intermediate-risk patients (OS, P=0.13; DFS, P=0.21).
Conclusion: The I-Bu conditioning regimen followed by ASCT provides durable survival benefits and a favorable safety profile for young, favorable-risk AML patients in CR1, representing a potential post-remission therapeutic option. Its role in intermediate-risk AML requires further validation.
期刊介绍：
Blood and Lymphatic Cancer: Targets and Therapy is an international, peer reviewed, open access journal focusing on blood and lymphatic cancer research, identification of therapeutic targets, and the optimal use of preventative and integrated treatment interventions to achieve improved outcomes, enhanced survival, and quality of life for the cancer patient. Specific topics covered in the journal include: Epidemiology, detection and screening Cellular research and biomarkers Identification of biotargets and agents with novel mechanisms of action Optimal clinical use of existing anticancer agents, including combination therapies Radiation, surgery, bone marrow transplantation Palliative care Patient adherence, quality of life, satisfaction Health economic evaluations.
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