Fludarabine plus reduced-intensity busulfan versus fludarabine plus myeloablative busulfan in patients with non-Hodgkin lymphoma undergoing allogeneic hematopoietic cell transplantation

Kimimori Kamijo, Yoshimitsu Shimomura, Akihito Shinohara, Shohei Mizuno, Minoru Kanaya, Yoshiaki Usui, Sung Won Kim, Takahide Ara, Ishikazu Mizuno, Takuro Kuriyama, Hideyuki Nakazawa, Ken ichi Matsuoka, Shigeru Kusumoto, Nobuo Maseki, Masaki Yamaguchi, Takashi Ashida, Makoto Onizuka, Takahiro Fukuda, Yoshiko Atsuta, Eisei Kondo

Research output: Contribution to journalArticlepeer-review

Abstract

Allogeneic hematopoietic cell transplantation (HCT) offers a possible cure for patients with relapsed and refractory non-Hodgkin lymphoma (NHL) through potentially beneficial graft versus lymphoma effects. However, allogeneic HCT is associated with high nonrelapse mortality (NRM). Fludarabine with reduced-intensity busulfan (Flu/Bu2) and myeloablative busulfan (Flu/Bu4) are commonly used in conditioning regimens for allogeneic HCT; however, data on their use in patients with NHL is limited. We investigated the effect of busulfan dose on outcomes by comparing Flu/Bu2 and Flu/Bu4 in patients with NHL who underwent allogeneic HCT. Our study included 415 adult patients with NHL who received Flu/Bu2 (315 patients) or Flu/Bu4 (100 patients) between January 2008 and December 2019. All patients were enrolled in the Transplant Registry Unified Management Program 2 of the Japanese Data Center for Hematopoietic Cell Transplantation. The primary endpoint was the 5-year overall survival (OS). To minimize potential confounding factors that may influence outcomes, we performed propensity score matching. The 5-year OS was 50.6% (95% confidence interval (CI), 39.4%–60.8%) and 32.2% (95% CI, 22.4–42.4%) in the Flu/Bu2 and Flu/Bu4 groups, respectively (p = 0.006). The hazard ratio comparing the two groups was 2.13 (95% CI, 1.30–3.50; p = 0.003). Both groups had a similar 5-year cumulative incidence of relapse (38.2% vs 41.3%; p = 0.581), and the Flu/Bu4 group had a higher cumulative incidence of 5-year NRM (15.7% vs 31.9%; p = 0.043). In this study, Flu/Bu4 was associated with worse OS compared with Flu/Bu2 because of high NRM in patients with NHL.

Original languageEnglish
JournalAnnals of Hematology
DOIs
Publication statusAccepted/In press - 2023

Keywords

  • Busulfan
  • Conditioning regimen
  • Lymphoma
  • Non-Hodgkin lymphoma
  • Stem cell transplantation

ASJC Scopus subject areas

  • Hematology

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