Better leukemia-free and overall survival in AML in first remission following cyclophosphamide in combination with busulfan compared with TBI

Edward A. Copelan, Betty K. Hamilton, Belinda Avalos, Kwang W. Ahn, Brian J. Bolwell, Xiaochun Zhu, Mahmoud Aljurf, Koen Van Besien, Christopher Bredeson, Jean Yves Cahn, Luciano J. Costa, Marcos De Lima, Robert P. Gale, Gregory A. Hale, Joerg Halter, Mehdi Hamadani, Yoshihiro Inamoto, Rammurti T. Kamble, Mark R Litzow, Alison W. LorenDavid I. Marks, Eduardo Olavarria, Vivek Roy, Mitchell Sabloff, Bipin N. Savani, Matthew Seftel, Harry C. Schouten, Celalettin Ustun, Edmund K. Waller, Daniel J. Weisdorf, Baldeep Wirk, Mary M. Horowitz, Mukta Arora, Jeff Szer, Jorge Cortes, Matt E. Kalaycio, Richard T. Maziarz, Wael Saber

Research output: Contribution to journalArticle

86 Citations (Scopus)

Abstract

Cyclophosphamide combined with total body irradiation (Cy/TBI) or busulfan (BuCy) are the most widely used myeloablative conditioning regimens for allotransplants. Recent data regarding their comparative effectiveness are lacking. We analyzed data from the Center for International Blood and Marrow Transplant Research for 1230 subjects receiving a first hematopoietic cell transplant from a human leukocyte antigen-matched sibling or from an unrelated donor during the years 2000 to 2006 for acute myeloid leukemia (AML) in first complete remission (CR) after conditioning with Cy/TBI or oral or intravenous (4) BuCy. Multivariate analysis showed significantly less nonrelapse mortality (relative risk [RR]= 0.58; 95% confidence interval [CI]: 0.39-0.86; P = .007), and relapse after, but not before, 1 year posttransplant (RR=0.23; 95% CI: 0.08-0.65; P=.006), and better leukemia-free survival (RR=0.70; 95% CI: 0.55-0.88; P = .003) and survival (RR = 0.68; 95% CI: 0.52-0.88; P = .003) in persons receiving 4, but not oral, Bu compared with TBI. In combination with Cy, 4 Bu is associated with superior outcomes compared with TBI in patients with AML in first CR.

Original languageEnglish (US)
Pages (from-to)3863-3870
Number of pages8
JournalBlood
Volume122
Issue number24
DOIs
StatePublished - Dec 5 2013

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Busulfan
Acute Myeloid Leukemia
Cyclophosphamide
Leukemia
Confidence Intervals
Transplants
Survival
Whole-Body Irradiation
Irradiation
Unrelated Donors
HLA Antigens
Siblings
Blood
Multivariate Analysis
Bone Marrow
Recurrence
Mortality
Research
Conditioning (Psychology)

ASJC Scopus subject areas

  • Hematology
  • Biochemistry
  • Cell Biology
  • Immunology

Cite this

Copelan, E. A., Hamilton, B. K., Avalos, B., Ahn, K. W., Bolwell, B. J., Zhu, X., ... Saber, W. (2013). Better leukemia-free and overall survival in AML in first remission following cyclophosphamide in combination with busulfan compared with TBI. Blood, 122(24), 3863-3870. https://doi.org/10.1182/blood-2013-07-514448

Better leukemia-free and overall survival in AML in first remission following cyclophosphamide in combination with busulfan compared with TBI. / Copelan, Edward A.; Hamilton, Betty K.; Avalos, Belinda; Ahn, Kwang W.; Bolwell, Brian J.; Zhu, Xiaochun; Aljurf, Mahmoud; Van Besien, Koen; Bredeson, Christopher; Cahn, Jean Yves; Costa, Luciano J.; De Lima, Marcos; Gale, Robert P.; Hale, Gregory A.; Halter, Joerg; Hamadani, Mehdi; Inamoto, Yoshihiro; Kamble, Rammurti T.; Litzow, Mark R; Loren, Alison W.; Marks, David I.; Olavarria, Eduardo; Roy, Vivek; Sabloff, Mitchell; Savani, Bipin N.; Seftel, Matthew; Schouten, Harry C.; Ustun, Celalettin; Waller, Edmund K.; Weisdorf, Daniel J.; Wirk, Baldeep; Horowitz, Mary M.; Arora, Mukta; Szer, Jeff; Cortes, Jorge; Kalaycio, Matt E.; Maziarz, Richard T.; Saber, Wael.

In: Blood, Vol. 122, No. 24, 05.12.2013, p. 3863-3870.

Research output: Contribution to journalArticle

Copelan, EA, Hamilton, BK, Avalos, B, Ahn, KW, Bolwell, BJ, Zhu, X, Aljurf, M, Van Besien, K, Bredeson, C, Cahn, JY, Costa, LJ, De Lima, M, Gale, RP, Hale, GA, Halter, J, Hamadani, M, Inamoto, Y, Kamble, RT, Litzow, MR, Loren, AW, Marks, DI, Olavarria, E, Roy, V, Sabloff, M, Savani, BN, Seftel, M, Schouten, HC, Ustun, C, Waller, EK, Weisdorf, DJ, Wirk, B, Horowitz, MM, Arora, M, Szer, J, Cortes, J, Kalaycio, ME, Maziarz, RT & Saber, W 2013, 'Better leukemia-free and overall survival in AML in first remission following cyclophosphamide in combination with busulfan compared with TBI', Blood, vol. 122, no. 24, pp. 3863-3870. https://doi.org/10.1182/blood-2013-07-514448
Copelan, Edward A. ; Hamilton, Betty K. ; Avalos, Belinda ; Ahn, Kwang W. ; Bolwell, Brian J. ; Zhu, Xiaochun ; Aljurf, Mahmoud ; Van Besien, Koen ; Bredeson, Christopher ; Cahn, Jean Yves ; Costa, Luciano J. ; De Lima, Marcos ; Gale, Robert P. ; Hale, Gregory A. ; Halter, Joerg ; Hamadani, Mehdi ; Inamoto, Yoshihiro ; Kamble, Rammurti T. ; Litzow, Mark R ; Loren, Alison W. ; Marks, David I. ; Olavarria, Eduardo ; Roy, Vivek ; Sabloff, Mitchell ; Savani, Bipin N. ; Seftel, Matthew ; Schouten, Harry C. ; Ustun, Celalettin ; Waller, Edmund K. ; Weisdorf, Daniel J. ; Wirk, Baldeep ; Horowitz, Mary M. ; Arora, Mukta ; Szer, Jeff ; Cortes, Jorge ; Kalaycio, Matt E. ; Maziarz, Richard T. ; Saber, Wael. / Better leukemia-free and overall survival in AML in first remission following cyclophosphamide in combination with busulfan compared with TBI. In: Blood. 2013 ; Vol. 122, No. 24. pp. 3863-3870.
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abstract = "Cyclophosphamide combined with total body irradiation (Cy/TBI) or busulfan (BuCy) are the most widely used myeloablative conditioning regimens for allotransplants. Recent data regarding their comparative effectiveness are lacking. We analyzed data from the Center for International Blood and Marrow Transplant Research for 1230 subjects receiving a first hematopoietic cell transplant from a human leukocyte antigen-matched sibling or from an unrelated donor during the years 2000 to 2006 for acute myeloid leukemia (AML) in first complete remission (CR) after conditioning with Cy/TBI or oral or intravenous (4) BuCy. Multivariate analysis showed significantly less nonrelapse mortality (relative risk [RR]= 0.58; 95{\%} confidence interval [CI]: 0.39-0.86; P = .007), and relapse after, but not before, 1 year posttransplant (RR=0.23; 95{\%} CI: 0.08-0.65; P=.006), and better leukemia-free survival (RR=0.70; 95{\%} CI: 0.55-0.88; P = .003) and survival (RR = 0.68; 95{\%} CI: 0.52-0.88; P = .003) in persons receiving 4, but not oral, Bu compared with TBI. In combination with Cy, 4 Bu is associated with superior outcomes compared with TBI in patients with AML in first CR.",
author = "Copelan, {Edward A.} and Hamilton, {Betty K.} and Belinda Avalos and Ahn, {Kwang W.} and Bolwell, {Brian J.} and Xiaochun Zhu and Mahmoud Aljurf and {Van Besien}, Koen and Christopher Bredeson and Cahn, {Jean Yves} and Costa, {Luciano J.} and {De Lima}, Marcos and Gale, {Robert P.} and Hale, {Gregory A.} and Joerg Halter and Mehdi Hamadani and Yoshihiro Inamoto and Kamble, {Rammurti T.} and Litzow, {Mark R} and Loren, {Alison W.} and Marks, {David I.} and Eduardo Olavarria and Vivek Roy and Mitchell Sabloff and Savani, {Bipin N.} and Matthew Seftel and Schouten, {Harry C.} and Celalettin Ustun and Waller, {Edmund K.} and Weisdorf, {Daniel J.} and Baldeep Wirk and Horowitz, {Mary M.} and Mukta Arora and Jeff Szer and Jorge Cortes and Kalaycio, {Matt E.} and Maziarz, {Richard T.} and Wael Saber",
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T1 - Better leukemia-free and overall survival in AML in first remission following cyclophosphamide in combination with busulfan compared with TBI

AU - Copelan, Edward A.

AU - Hamilton, Betty K.

AU - Avalos, Belinda

AU - Ahn, Kwang W.

AU - Bolwell, Brian J.

AU - Zhu, Xiaochun

AU - Aljurf, Mahmoud

AU - Van Besien, Koen

AU - Bredeson, Christopher

AU - Cahn, Jean Yves

AU - Costa, Luciano J.

AU - De Lima, Marcos

AU - Gale, Robert P.

AU - Hale, Gregory A.

AU - Halter, Joerg

AU - Hamadani, Mehdi

AU - Inamoto, Yoshihiro

AU - Kamble, Rammurti T.

AU - Litzow, Mark R

AU - Loren, Alison W.

AU - Marks, David I.

AU - Olavarria, Eduardo

AU - Roy, Vivek

AU - Sabloff, Mitchell

AU - Savani, Bipin N.

AU - Seftel, Matthew

AU - Schouten, Harry C.

AU - Ustun, Celalettin

AU - Waller, Edmund K.

AU - Weisdorf, Daniel J.

AU - Wirk, Baldeep

AU - Horowitz, Mary M.

AU - Arora, Mukta

AU - Szer, Jeff

AU - Cortes, Jorge

AU - Kalaycio, Matt E.

AU - Maziarz, Richard T.

AU - Saber, Wael

PY - 2013/12/5

Y1 - 2013/12/5

N2 - Cyclophosphamide combined with total body irradiation (Cy/TBI) or busulfan (BuCy) are the most widely used myeloablative conditioning regimens for allotransplants. Recent data regarding their comparative effectiveness are lacking. We analyzed data from the Center for International Blood and Marrow Transplant Research for 1230 subjects receiving a first hematopoietic cell transplant from a human leukocyte antigen-matched sibling or from an unrelated donor during the years 2000 to 2006 for acute myeloid leukemia (AML) in first complete remission (CR) after conditioning with Cy/TBI or oral or intravenous (4) BuCy. Multivariate analysis showed significantly less nonrelapse mortality (relative risk [RR]= 0.58; 95% confidence interval [CI]: 0.39-0.86; P = .007), and relapse after, but not before, 1 year posttransplant (RR=0.23; 95% CI: 0.08-0.65; P=.006), and better leukemia-free survival (RR=0.70; 95% CI: 0.55-0.88; P = .003) and survival (RR = 0.68; 95% CI: 0.52-0.88; P = .003) in persons receiving 4, but not oral, Bu compared with TBI. In combination with Cy, 4 Bu is associated with superior outcomes compared with TBI in patients with AML in first CR.

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