Fludarabine/busulfan versus busulfan/cyclophosphamide as myeloablative conditioning for myelodysplastic syndrome: a propensity score-matched analysis

Shuhei Kurosawa, Yoshimitsu Shimomura, Hidehiro Itonaga, Yuho Najima, Takeshi Kobayashi, Yukiyasu Ozawa, Yoshinobu Kanda, Shinichi Kako, Toshiro Kawakita, Ken ichi Matsuoka, Yumiko Maruyama, Shuichi Ota, Hideyuki Nakazawa, Kazunori Imada, Junya Kanda, Takahiro Fukuda, Yoshiko Atsuta, Jun Aoki

Research output: Contribution to journalArticlepeer-review

Abstract

Myeloablative conditioning with fludarabine/busulfan (Flu/Bu4) prior to allogeneic hematopoietic stem cell transplantation (allo-HSCT) is effective for acute myeloid leukemia. However, the effectiveness of Flu/Bu4 for myelodysplastic syndrome (MDS) remains poorly understood. Therefore, we retrospectively analyzed nationwide registry data in Japan from 2006 to 2018 and compared transplant outcomes of adult MDS patients receiving Flu/Bu4 and busulfan/cyclophosphamide (Bu4/Cy) using propensity score (PS) matching. The primary endpoint was overall survival (OS). Among 2,482 MDS patients, 153 patients were assigned each to the Flu/Bu4 and Bu4/Cy groups. The 3-year OS rates were 52.7% (95% confidence interval [CI], 43.8–60.8%) and 49.5% (95% CI, 40.8–57.6%) in the Flu/Bu4 and Bu4/Cy group, respectively (P = 0.548). The 3-year progression-free survival (P = 0.858), the cumulative incidence of relapse (P = 0.536), and cumulative incidence of non-relapse mortality (P = 0.684) were not significantly different between the two groups. According to the findings of subgroup analyses, no patient had a favorable OS when using either of the two regimens. In conclusion, although our PS-matched cohort mainly comprised older patients who had a low hematopoietic cell transplantation-comorbidity index and low-risk disease status, Flu/Bu4 could be an alternative to Bu4/Cy for MDS patients prior to allo-HSCT.

Original languageEnglish
JournalBone Marrow Transplantation
DOIs
Publication statusAccepted/In press - 2021
Externally publishedYes

ASJC Scopus subject areas

  • Hematology
  • Transplantation

Fingerprint

Dive into the research topics of 'Fludarabine/busulfan versus busulfan/cyclophosphamide as myeloablative conditioning for myelodysplastic syndrome: a propensity score-matched analysis'. Together they form a unique fingerprint.

Cite this