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Conditioning Regimens

Fludarabine Melphalan reduced-intensity conditioning allotransplanation provides similar disease control in lymphoid and myeloid malignancies: analysis of 344 patients

Bone Marrow Transplantation volume 49, pages 17–23 (2014)Cite this article

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Abstract

This was an Australasian Bone Marrow Transplant Recipient Registry (ABMTRR)-based retrospective study assessing the outcome of Fludarabine Melphalan (FluMel) reduced-intensity conditioning between 1998 and 2008. Median follow-up was 3.4 years. There were 344 patients with a median age of 54 years (18–68). In all, 234 patients had myeloid malignancies, with AML (n=166) being the commonest indication. There were 110 lymphoid patients with non-hodgkins lymphoma (NHL) (n=64) the main indication. TRM at day 100 was 14% with no significant difference between the groups. OS and disease-free survival (DFS) were similar between myeloid and lymphoid patients (57 and 50% at 3 years, respectively). There was no difference in cumulative incidence of relapse or GVHD between groups. Multivariate analysis revealed four significant adverse risk factors for DFS: donor other than HLA-identical sibling donor, not in remission at transplant, previous autologous transplant and recipient CMV positive. Chronic GVHD was associated with improved DFS in multivariate analysis predominantly due to a marked reduction in relapse (HR:0.44, P=0.003). This study confirms that FluMel provides durable and equivalent remissions in both myeloid and lymphoid malignancies. Disease stage and chronic GVHD remain important determinants of outcome for FluMel allografting.

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Author notes

  1. A Bryant and I Nivison-Smith: These authors contribued equally to this work.

Authors and Affiliations

  1. St Vincent’s Hospital, Darlinghurst, New South Wales, Australia

    A Bryant, K Fay & J Moore

  2. Australasian Bone Marrow Transplant Recipient Registry, New South Wales, Sydney, Australia

    I Nivison-Smith

  3. Royal Brisbane Hospital, Herston, Queensland, Australia

    E S Pillai & G Kennedy

  4. Royal Melbourne Hospital, Parkville, Victoria, Australia

    A Kalff & D Ritchie

  5. Westmead Hospital, Westmead, New South Wales, Australia

    B George & M Hertzberg

  6. The Alfred Hospital, Melbourne, Victoria, Australia

    S Patil & A Spencer

  7. Royal North Shore Hospital, New South Wales, Sydney, Australia

    K Fay

  8. Royal Perth Hospital, Perth, Western Australia, Australia

    P Cannell

  9. Auckland City Hospital, Auckland, New Zealand

    L Berkahn & R Doocey

  10. Christchurch City Hospital, Christchurch, New Zealand

    R Spearing

Authors
  1. A Bryant
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  16. J Moore
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Corresponding author

Correspondence to J Moore.

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Competing interests

Andrew Spencer has received research support from Celgene, Janssen and Novartis. The remaining authors declare no conflict of interest.

Additional information

This study has been presented in part at the HAA/APBMT meeting in Sydney, Australia in October 2011 and ASH, San Diego, USA, December 2011.

Author Contributions

AB, IN-S and JM designed the study, compiled the data, analysed the data, and wrote and approved the final manuscript. ESP, GK, AK, DR, BG, MH, SP, AS, KF, PC, LB, RD and RS compiled the data, and wrote and approved the final manuscript.

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Bryant, A., Nivison-Smith, I., Pillai, E. et al. Fludarabine Melphalan reduced-intensity conditioning allotransplanation provides similar disease control in lymphoid and myeloid malignancies: analysis of 344 patients. Bone Marrow Transplant 49, 17–23 (2014). https://doi.org/10.1038/bmt.2013.142

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