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Reduced-intensity versus reduced-toxicity myeloablative fludarabine/busulfan-based conditioning regimens for allografted non-Hodgkin lymphoma adult patients: a retrospective study on behalf of the Societe Francophone de Greffe de Moelle et de Therapie Cellulaire
Le Bourgeois, A., Labopin, M., Blaise, D., Ceballos, P., Vigouroux, S., Peffault de Latour, R., Marcais, A., Bulabois, C. E., Bay, J. O., Chantepie, S., et al
Annals of Oncology. 2017;28(9):2191-2198
Abstract
Background: Fludarabine/busulfan-based conditioning regimens are widely used to perform allogeneic stem-cell transplantation (allo-SCT) in high-risk non-Hodgkin lymphoma (NHL) patients. The impact of the dose intensity of busulfan on outcomes has not been reported yet. Patients and methods: This was a retrospective with the aim to compare the outcomes of NHL patients who received before allo-SCT a fludarabine/busulfan conditioning regimen, either of reduced intensity (FB2, 2 days of busulfan at 4mg/kg/day oral or 3.2mg/kg/day i.v.) (n=277) or at a myeloablative reduced-toxicity dose (FB3/FB4, 3 or 4 days of busulfan at 4mg/kg/day oral or 3.2mg/kg/day i.v.) (n=101). Results: In univariate analysis, the 2-year overall survival (FB266.5% versus 60.3%, P=0.33), lymphoma-free survival (FB257.9% versus 49.8%, P=0.26), and non-relapse mortality (FB219% versus 21.1%, P=0.91) were similar between both groups. Cumulative incidence of grade III-IV acute graft versus host disease (GVHD) (FB211.2% versus 18%, P=0.08), extensive chronic GVHD (FB2: 17.3% versus 10.7%, P=0.18) and 2-year GVHD free-relapse free survival (FB2: 44.4% versus 42.8%, P=0.38) were also comparable. In multivariate analysis there was a trend for a worse outcome using FB3/FB4 regimens (overall survival: HR 1.47, 95% CI: 0.96-2.24, P=0.08; lymphoma-free survival: HR: 1.43, 95% CI: 0.99-2.06, P=0.05; relapse incidence: HR 1.54; 95% CI: 0.96-2.48, P=0.07). These results were confirmed using a propensity score-matching strategy. Conclusion: We conclude that reduced toxicity myeloablative conditioning with fludarabine/busulfan does not improve the outcomes compared with reduced-intensity conditioning in adults receiving allo-SCT for NHL.