Comparing treosulfan and busulfan based conditioning treatment for patients with acute myeloid leukemia before transplant

This study aimed to investigate the long-term survival outcomes of treosulfan (Trecondi)-based versus busulfan (Myleran)-based conditioning treatment in patients with acute myeloid leukemia.

This study concluded that treosulfan-based conditioning treatment may have better outcomes for these patients.  

Patients with acute myeloid leukemia (AML) benefit from an allogeneic hemopoietic stem cell transplant (alloHSCT). AlloHSCT is where healthy blood stem cells are transplanted from a donor to a patient to replace disease or damaged cells after cancer treatment. A conditioning regimen is used before alloHSCT to kill cancer cells and help prevent the patient's body from rejecting the transplant. It can include chemotherapy, immunotherapy, and radiation.  

The most commonly used conditioning regimens for AML include busulfan chemotherapy. However, busulfan is associated with a high risk of side effects. Treosulfan is another chemotherapy that can be used as a conditioning treatment. It is known to have fewer side effects. However, the safety and effectiveness of treosulfan-based conditioning regimens for alloHSCT compared with busulfan-based regimens in AML are still not clear.

This study reviewed six studies that involved 3982 patients who had AML or myelodysplastic syndrome. Patients received either treosulfan– or busulfan-based condition regimens followed by alloHSCT. 

There was a trend towards a better overall survival rate (by 20%) for patients who received treosulfan-based conditioning compared to those who received busulfan-based conditioning. There was no difference between non-relapse mortality and leukemia-free survival between the treosulfan and busulfan groups.  

Patients who received treosulfan had a slightly lower risk (by 30%) of short-term graft-versus-host-disease (GVHD) when compared to the busulfan group. GVHD is where the transplanted cells attack the healthy cells of the patient. There was no significant difference between the two groups in the occurrence of long-term GVHD or relapse.

This study concluded that treosulfan-based conditioning treatment may have better outcomes than busulfan-based regimens for patients with AML undergoing alloHSCT.

Most of the studies analyzed were based on medical records. Also, the protocols of the studies were different. Further randomized studies are needed to confirm these findings.