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Leuk Res. 2015 Sep;39(9):933-7. doi: 10.1016/j.leukres.2015.04.009. Epub 2015 Apr 24.

Higher busulfan dose intensity appears to improve leukemia-free and overall survival in AML allografted in CR2: An analysis from the Acute Leukemia Working Party of the European Group for Blood and Marrow Transplantation.

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Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center, Tampa, FL, United States.
Acute Leukemia Working Party of EBMT, Paris, France.
Division of Hematology-Oncology and BMT Program, American University of Beirut Medical Center, Beirut, Lebanon.
Service d'Hématologie Greffe, Hôpital Saint Louis, Paris, France.
Bone Marrow Transplantation Centre, Univ. Hospital Eppendorf, Hamburg, Germany.
Unité de Transplantation et de Thérapie Cellulaire (U2T), Institut Paoli-Calmettes, Marseille, France.
Leiden University Medical Center, Leiden, The Netherlands.
Dept of Hematology, Hospital Universitario Marqués de Valdecilla, Instituto de Formación e Investigación Marqués de Valdecilla, Santander, Spain.
Dept of Bone Marrow Transplantation and Cancer Immunotherapy, Hadassah University Hospital, Jerusalem, Israel.
CHU Hautepierre-Département d'Hématologie et Oncologie, Strasbourg, France.
University Hospital, Department of Bone Marrow Transplantation, Essen, Germany.
Service d'Hématologie, CHU, Montpellier, France.
Centre Pierre et Marie Curie, Alger, Algeria.
Acute Leukemia Working Party of EBMT, Paris, France; Hematology Division, Chaim Sheba Medical Center, Tel Hashomer, Israel.
Acute Leukemia Working Party of EBMT, Paris, France; Département d'Hématologie, Hopital Saint Antoine, Paris, France. Electronic address:


Allogeneic hematopoietic cell transplantation is a potentially curative treatment in patients with acute myeloid leukemia. Recent advances in the field of hematopoietic cell allografting have resulted in a practice shift, favoring less intense preparative regimens. We present results of a retrospective comparative analysis of two preparative regimens, namely FB2 (IV fludarabine plus IV busulfan 6.4mg/kg±10%) and FB4 (IV fludarabine plus IV busulfan 12.8mg/kg ±10%), in patients with acute myeloid leukemia undergoing hematopoietic cell allografting in second complete remission at EBMT participating centers. Between 2003 and 2010, 128 AML patients in second complete remission were allografted following a preparative regimen of FB2 (n=88) or FB4 (n=40). The median time-to-neutrophil engraftment was similar whether patients received FB2 (16 (5-38) days) or FB4 (16 (9-29) days), p=0.45. A multivariate analysis showed that use of FB4 resulted in improved 2-year leukemia-free (HR=0.44 (95%CI=0.21, 0.94), p=0.03) and overall survival (HR=0.38 (95%CI=0.16, 0.86), p=0.02). Cumulative incidence of non-relapse mortality (2-year) for all patients was 21% (95%CI=14-28%). Our analysis suggests that FB4 improves 2-year leukemia-free and overall survival in AML allografted in second complete remission. A confirmatory randomized controlled trial that compares these two preparative regimens (FB2 vs. FB4) in AML in CR2 is definitely warranted.


Acute myeloid leukemia; Allogeneic hematopoietic cell transplantation; Leukemia-free survival; Overall survival; Second complete remission

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