Comparing conditioning treatments for patients with acute myeloid leukemia undergoing stem cell transplant

This study aimed to investigate two pre-transplant conditioning regimes for patients with acute myeloid leukemia. 

This study concluded that total body irradiation and fludarabine (Fludara) may be a suitable reduced toxicity conditioning treatment option for these patients.

A conditioning treatment is used to prepare a patient for hematopoietic stem cell transplant (HSCT). It aims to destroy cancer cells. HSCT is where a patient receives helthy stem cells to replace the cancer cells destroyed by the conditioning treatment. HSCT can be done with cells from the patients (autologous) or from a donor (allogeneic). The conditioning regimen can also help prevent the patient's body from rejecting transplanted cells.  

The optimal conditioning for patients with acute myeloid leukaemia (AML) in first complete remission treated with allogeneic HSCT (allo-HSCT) is unknown. 

This study involved 518 patients with AML preparing to receive an allo-HSCT. All patients received a ‘’reduced-toxicity’’ conditioning treatment. One group received conditioning with busulfan (Myleran) and fludarabine (the Bu-Flu group). The other group received total body irradiation (TBI) and fludarabine (the TBI-Flu group). Patients in the BU-Flu group were followed-up for an average of 23 months and those in the TBI-Flu group for an average of 57 months. 

At 2 years, the overall survival rate was 62% for the Bu-Flu group compared to 72.5% for the TBI-Flu group. At 2 years, the leukemia-free survival rate was 59.5% for the Bu-Flu group compared to 66% for the TBI-Flu group. At 2 years, the relapse rate was 30% for the Bu-Flu group compared to 20% for the TBI-Flu group.  

In patients aged 50 or older, the use of TBI-Flu was associated with a 3.9 times higher risk of mortality not caused by leukemia relapse.  

This study concluded that TBI-Flu may be suitable as a ‘reduced toxicity’ conditioning regimen in younger patients with AML who are going to have allo-HSCT. 

This study was based on medical records. Information might have been incomplete.