Fludarabine and Melphalan Compared with Reduced Doses of Busulfan and Fludarabine Improve Transplantation Outcomes in Older Patients with Myelodysplastic Syndromes
Betül Oran, Kwang Woo Ahn, Caitrin Fretham, Amer Beitinjaneh, Asad Bashey, Attaphol Pawarode, Baldeep Wirk, Bart L. Scott, Bipin N. Savani, Christopher Bredeson, Daniel J. Weisdorf, David I. Marks, David A. Rizzieri, Edward A. Copelan, Gerhard Hildebrandt, Gregory A. Hale, Hemant S. Murthy, Hillard M. Lazarus, Jan Černý, Jane L. Liesveld, Jean A. Yared, Jean Yves-Cahn, Jeff Szer, Leo F. Verdonck, Mahmoud Aljurf, Marjolein van der Poel, Mark R. Litzow, Matt Kalaycio, Michael R. Grunwald, Miguel Ángel Díaz, Mitchell Sabloff, Mohamed A. Kharfan‐Dabaja, Navneet S. Majhail, Nosha Farhadfar, Ran Reshef, Richard F. Olsson, Robert Peter Gale, Ryotaro Nakamura, Sachiko Seo, Saurabh Chhabra, Shahrukh K. Hashmi, Shatha Farhan, Siddhartha Ganguly, Sunita Nathan, Taiga Nishihori, Tania Jain, Vaibhav Agrawal, Ulrike Bacher, Uday Popat, Wael Saber
Abstract
. The 2 groups, recipients of FluBu (n = 697) and recipients of FluMel (n = 448), were comparable in terms of disease- and transplantation-related characteristics except for the more frequent use of antithymocyte globulin or alemtuzumab in the FluBu group (39% versus 31%). The median age was 67 years in both groups. FluMel was associated with a reduced relapse incidence (RI) compared with FluBu, with a 1-year adjusted incidence of 26% versus 44% (P ≤ .0001). Transplantation-related mortality (TRM) was higher in the FluMel group (26% versus 16%; P ≤ .0001). Because the magnitude of improvement with FluMel in RI was greater than the improvement in TRM with FluBu, disease-free survival (DFS) was better at 1 year and beyond with FluMel compared with FluBu (48% versus 40% at 1 year [P = .02] and 35% versus 27% at 3 years [P = .01]). Overall survival was comparable in the 2 groups at 1 year (63% versus 61%; P = .4) but was significantly improved with FluMel compared with FluBu at 3 years (46% versus 39%; P = .03). Our results suggest that FluMel is associated with superior DFS compared with FluBu owing to reduced RI in older patients with MDS patients. © 2021 American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc.