Multivariable analysis suggests that PSI using a higher intensity of IV busulfan (such as in FB4) results in better 2-year LFS and OS in AML patients transplanted in CR2. This highlights the importance of busulfan dose intensity when allografting patients with more advance disease stage. The benefit of using FB4 vs. FB2 in our analysis is probably derived from a lower NRM (Table 2). However, the “anti-leukemia effect” of busulfan dose-intensity remains a highly argued issue with several doses being tested in a prospective study (ClinicalTrials.gov Identifier: NCT01985061). A previously published retrospective analysis using the Seattle regimen of 2 Gy TBI with or without fludarabine showed an inferior 5-year OS in patients with advanced AML compared to those in CR1 or CR2, respectively (18% vs. 37% vs. 34%, p = 0.008) [13]. Ringden et al. showed dictyosomes RIC regimens for allo-HCT using unrelated donors resulted in higher relapses in patients younger than 50 years of age and decreased NRM in those ≥50 years when compared to using MAC regimens [14].
↧