Cargando…
Fludarabine plus reduced-intensity busulfan versus fludarabine plus myeloablative busulfan in patients with non-Hodgkin lymphoma undergoing allogeneic hematopoietic cell transplantation
Allogeneic hematopoietic cell transplantation (HCT) offers a possible cure for patients with relapsed and refractory non-Hodgkin lymphoma (NHL) through potentially beneficial graft versus lymphoma effects. However, allogeneic HCT is associated with high nonrelapse mortality (NRM). Fludarabine with r...
Autores principales: | , , , , , , , , , , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer Berlin Heidelberg
2023
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9977852/ https://www.ncbi.nlm.nih.gov/pubmed/36631705 http://dx.doi.org/10.1007/s00277-023-05084-x |
_version_ | 1784899385682821120 |
---|---|
author | Kamijo, Kimimori Shimomura, Yoshimitsu Shinohara, Akihito Mizuno, Shohei Kanaya, Minoru Usui, Yoshiaki Kim, Sung-Won Ara, Takahide Mizuno, Ishikazu Kuriyama, Takuro Nakazawa, Hideyuki Matsuoka, Ken-ichi Kusumoto, Shigeru Maseki, Nobuo Yamaguchi, Masaki Ashida, Takashi Onizuka, Makoto Fukuda, Takahiro Atsuta, Yoshiko Kondo, Eisei |
author_facet | Kamijo, Kimimori Shimomura, Yoshimitsu Shinohara, Akihito Mizuno, Shohei Kanaya, Minoru Usui, Yoshiaki Kim, Sung-Won Ara, Takahide Mizuno, Ishikazu Kuriyama, Takuro Nakazawa, Hideyuki Matsuoka, Ken-ichi Kusumoto, Shigeru Maseki, Nobuo Yamaguchi, Masaki Ashida, Takashi Onizuka, Makoto Fukuda, Takahiro Atsuta, Yoshiko Kondo, Eisei |
author_sort | Kamijo, Kimimori |
collection | PubMed |
description | Allogeneic hematopoietic cell transplantation (HCT) offers a possible cure for patients with relapsed and refractory non-Hodgkin lymphoma (NHL) through potentially beneficial graft versus lymphoma effects. However, allogeneic HCT is associated with high nonrelapse mortality (NRM). Fludarabine with reduced-intensity busulfan (Flu/Bu2) and myeloablative busulfan (Flu/Bu4) are commonly used in conditioning regimens for allogeneic HCT; however, data on their use in patients with NHL is limited. We investigated the effect of busulfan dose on outcomes by comparing Flu/Bu2 and Flu/Bu4 in patients with NHL who underwent allogeneic HCT. Our study included 415 adult patients with NHL who received Flu/Bu2 (315 patients) or Flu/Bu4 (100 patients) between January 2008 and December 2019. All patients were enrolled in the Transplant Registry Unified Management Program 2 of the Japanese Data Center for Hematopoietic Cell Transplantation. The primary endpoint was the 5-year overall survival (OS). To minimize potential confounding factors that may influence outcomes, we performed propensity score matching. The 5-year OS was 50.6% (95% confidence interval (CI), 39.4%–60.8%) and 32.2% (95% CI, 22.4–42.4%) in the Flu/Bu2 and Flu/Bu4 groups, respectively (p = 0.006). The hazard ratio comparing the two groups was 2.13 (95% CI, 1.30–3.50; p = 0.003). Both groups had a similar 5-year cumulative incidence of relapse (38.2% vs 41.3%; p = 0.581), and the Flu/Bu4 group had a higher cumulative incidence of 5-year NRM (15.7% vs 31.9%; p = 0.043). In this study, Flu/Bu4 was associated with worse OS compared with Flu/Bu2 because of high NRM in patients with NHL. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00277-023-05084-x. |
format | Online Article Text |
id | pubmed-9977852 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Springer Berlin Heidelberg |
record_format | MEDLINE/PubMed |
spelling | pubmed-99778522023-03-03 Fludarabine plus reduced-intensity busulfan versus fludarabine plus myeloablative busulfan in patients with non-Hodgkin lymphoma undergoing allogeneic hematopoietic cell transplantation Kamijo, Kimimori Shimomura, Yoshimitsu Shinohara, Akihito Mizuno, Shohei Kanaya, Minoru Usui, Yoshiaki Kim, Sung-Won Ara, Takahide Mizuno, Ishikazu Kuriyama, Takuro Nakazawa, Hideyuki Matsuoka, Ken-ichi Kusumoto, Shigeru Maseki, Nobuo Yamaguchi, Masaki Ashida, Takashi Onizuka, Makoto Fukuda, Takahiro Atsuta, Yoshiko Kondo, Eisei Ann Hematol Original Article Allogeneic hematopoietic cell transplantation (HCT) offers a possible cure for patients with relapsed and refractory non-Hodgkin lymphoma (NHL) through potentially beneficial graft versus lymphoma effects. However, allogeneic HCT is associated with high nonrelapse mortality (NRM). Fludarabine with reduced-intensity busulfan (Flu/Bu2) and myeloablative busulfan (Flu/Bu4) are commonly used in conditioning regimens for allogeneic HCT; however, data on their use in patients with NHL is limited. We investigated the effect of busulfan dose on outcomes by comparing Flu/Bu2 and Flu/Bu4 in patients with NHL who underwent allogeneic HCT. Our study included 415 adult patients with NHL who received Flu/Bu2 (315 patients) or Flu/Bu4 (100 patients) between January 2008 and December 2019. All patients were enrolled in the Transplant Registry Unified Management Program 2 of the Japanese Data Center for Hematopoietic Cell Transplantation. The primary endpoint was the 5-year overall survival (OS). To minimize potential confounding factors that may influence outcomes, we performed propensity score matching. The 5-year OS was 50.6% (95% confidence interval (CI), 39.4%–60.8%) and 32.2% (95% CI, 22.4–42.4%) in the Flu/Bu2 and Flu/Bu4 groups, respectively (p = 0.006). The hazard ratio comparing the two groups was 2.13 (95% CI, 1.30–3.50; p = 0.003). Both groups had a similar 5-year cumulative incidence of relapse (38.2% vs 41.3%; p = 0.581), and the Flu/Bu4 group had a higher cumulative incidence of 5-year NRM (15.7% vs 31.9%; p = 0.043). In this study, Flu/Bu4 was associated with worse OS compared with Flu/Bu2 because of high NRM in patients with NHL. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00277-023-05084-x. Springer Berlin Heidelberg 2023-01-12 2023 /pmc/articles/PMC9977852/ /pubmed/36631705 http://dx.doi.org/10.1007/s00277-023-05084-x Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . |
spellingShingle | Original Article Kamijo, Kimimori Shimomura, Yoshimitsu Shinohara, Akihito Mizuno, Shohei Kanaya, Minoru Usui, Yoshiaki Kim, Sung-Won Ara, Takahide Mizuno, Ishikazu Kuriyama, Takuro Nakazawa, Hideyuki Matsuoka, Ken-ichi Kusumoto, Shigeru Maseki, Nobuo Yamaguchi, Masaki Ashida, Takashi Onizuka, Makoto Fukuda, Takahiro Atsuta, Yoshiko Kondo, Eisei Fludarabine plus reduced-intensity busulfan versus fludarabine plus myeloablative busulfan in patients with non-Hodgkin lymphoma undergoing allogeneic hematopoietic cell transplantation |
title | Fludarabine plus reduced-intensity busulfan versus fludarabine plus myeloablative busulfan in patients with non-Hodgkin lymphoma undergoing allogeneic hematopoietic cell transplantation |
title_full | Fludarabine plus reduced-intensity busulfan versus fludarabine plus myeloablative busulfan in patients with non-Hodgkin lymphoma undergoing allogeneic hematopoietic cell transplantation |
title_fullStr | Fludarabine plus reduced-intensity busulfan versus fludarabine plus myeloablative busulfan in patients with non-Hodgkin lymphoma undergoing allogeneic hematopoietic cell transplantation |
title_full_unstemmed | Fludarabine plus reduced-intensity busulfan versus fludarabine plus myeloablative busulfan in patients with non-Hodgkin lymphoma undergoing allogeneic hematopoietic cell transplantation |
title_short | Fludarabine plus reduced-intensity busulfan versus fludarabine plus myeloablative busulfan in patients with non-Hodgkin lymphoma undergoing allogeneic hematopoietic cell transplantation |
title_sort | fludarabine plus reduced-intensity busulfan versus fludarabine plus myeloablative busulfan in patients with non-hodgkin lymphoma undergoing allogeneic hematopoietic cell transplantation |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9977852/ https://www.ncbi.nlm.nih.gov/pubmed/36631705 http://dx.doi.org/10.1007/s00277-023-05084-x |
work_keys_str_mv | AT kamijokimimori fludarabineplusreducedintensitybusulfanversusfludarabineplusmyeloablativebusulfaninpatientswithnonhodgkinlymphomaundergoingallogeneichematopoieticcelltransplantation AT shimomurayoshimitsu fludarabineplusreducedintensitybusulfanversusfludarabineplusmyeloablativebusulfaninpatientswithnonhodgkinlymphomaundergoingallogeneichematopoieticcelltransplantation AT shinoharaakihito fludarabineplusreducedintensitybusulfanversusfludarabineplusmyeloablativebusulfaninpatientswithnonhodgkinlymphomaundergoingallogeneichematopoieticcelltransplantation AT mizunoshohei fludarabineplusreducedintensitybusulfanversusfludarabineplusmyeloablativebusulfaninpatientswithnonhodgkinlymphomaundergoingallogeneichematopoieticcelltransplantation AT kanayaminoru fludarabineplusreducedintensitybusulfanversusfludarabineplusmyeloablativebusulfaninpatientswithnonhodgkinlymphomaundergoingallogeneichematopoieticcelltransplantation AT usuiyoshiaki fludarabineplusreducedintensitybusulfanversusfludarabineplusmyeloablativebusulfaninpatientswithnonhodgkinlymphomaundergoingallogeneichematopoieticcelltransplantation AT kimsungwon fludarabineplusreducedintensitybusulfanversusfludarabineplusmyeloablativebusulfaninpatientswithnonhodgkinlymphomaundergoingallogeneichematopoieticcelltransplantation AT aratakahide fludarabineplusreducedintensitybusulfanversusfludarabineplusmyeloablativebusulfaninpatientswithnonhodgkinlymphomaundergoingallogeneichematopoieticcelltransplantation AT mizunoishikazu fludarabineplusreducedintensitybusulfanversusfludarabineplusmyeloablativebusulfaninpatientswithnonhodgkinlymphomaundergoingallogeneichematopoieticcelltransplantation AT kuriyamatakuro fludarabineplusreducedintensitybusulfanversusfludarabineplusmyeloablativebusulfaninpatientswithnonhodgkinlymphomaundergoingallogeneichematopoieticcelltransplantation AT nakazawahideyuki fludarabineplusreducedintensitybusulfanversusfludarabineplusmyeloablativebusulfaninpatientswithnonhodgkinlymphomaundergoingallogeneichematopoieticcelltransplantation AT matsuokakenichi fludarabineplusreducedintensitybusulfanversusfludarabineplusmyeloablativebusulfaninpatientswithnonhodgkinlymphomaundergoingallogeneichematopoieticcelltransplantation AT kusumotoshigeru fludarabineplusreducedintensitybusulfanversusfludarabineplusmyeloablativebusulfaninpatientswithnonhodgkinlymphomaundergoingallogeneichematopoieticcelltransplantation AT masekinobuo fludarabineplusreducedintensitybusulfanversusfludarabineplusmyeloablativebusulfaninpatientswithnonhodgkinlymphomaundergoingallogeneichematopoieticcelltransplantation AT yamaguchimasaki fludarabineplusreducedintensitybusulfanversusfludarabineplusmyeloablativebusulfaninpatientswithnonhodgkinlymphomaundergoingallogeneichematopoieticcelltransplantation AT ashidatakashi fludarabineplusreducedintensitybusulfanversusfludarabineplusmyeloablativebusulfaninpatientswithnonhodgkinlymphomaundergoingallogeneichematopoieticcelltransplantation AT onizukamakoto fludarabineplusreducedintensitybusulfanversusfludarabineplusmyeloablativebusulfaninpatientswithnonhodgkinlymphomaundergoingallogeneichematopoieticcelltransplantation AT fukudatakahiro fludarabineplusreducedintensitybusulfanversusfludarabineplusmyeloablativebusulfaninpatientswithnonhodgkinlymphomaundergoingallogeneichematopoieticcelltransplantation AT atsutayoshiko fludarabineplusreducedintensitybusulfanversusfludarabineplusmyeloablativebusulfaninpatientswithnonhodgkinlymphomaundergoingallogeneichematopoieticcelltransplantation AT kondoeisei fludarabineplusreducedintensitybusulfanversusfludarabineplusmyeloablativebusulfaninpatientswithnonhodgkinlymphomaundergoingallogeneichematopoieticcelltransplantation |