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Rasor B, Dickerson T, Zhao Q, Elder P, Brammer JE, Larkin K, Jaglowski S, Mims A, Penza S, Vasu S, Wall SA, William B, Saad A, Roddy JVF, Choe H, Puto M. Comparison of fixed dose reduced-intensity conditioning with fludarabine and busulfan to PK-guided busulfan AUC (FluBu4K) in hematopoietic stem cell transplant for AML/MDS. Leuk Lymphoma 2021; 62:944-951. [PMID: 33231122 PMCID: PMC8012251 DOI: 10.1080/10428194.2020.1849677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 11/01/2020] [Accepted: 11/05/2020] [Indexed: 10/22/2022]
Abstract
A retrospective cohort study was conducted to assess differences in efficacy and tolerability between a busulfan AUC target of 16.4 mg × Hr/L per day (FluBu4K) and a conventional RIC regimen (FluBu2). Adult patients with a diagnosis of AML or MDS who received fludarabine + busulfan conditioning with or without antithymocyte globulin between 2015 and 2018 were included. The primary outcome was relapse free survival. Overall, 74 patients received conditioning with either FluBu4K or FluBu2. At 18 months, relapse-free survival was not significantly different, at 63.9% with FluBu4k compared to 57.5% with FluBu2 (p = 0.49). There was a statistically significant difference in the cumulative incidence of relapse at 18 months in favor of the FluBu4K regimen, at 12.0% vs 32.5% (p = 0.047). The results of this study indicate that for select patients, there may be benefit in choosing targeted FluBu4K over FluBu2. Adverse effects other than mucositis were not significantly different.
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Affiliation(s)
- Brendan Rasor
- Department of Pharmacy, James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, OH, USA
- Department of Pharmacy, Kettering Health Network, Kettering, OH, USA
| | - Tyler Dickerson
- Department of Pharmacy, James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Qiuhong Zhao
- Division of Hematology, Department of Internal Medicine, James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Patrick Elder
- Division of Hematology, Department of Internal Medicine, James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Jonathan E Brammer
- Division of Hematology, Department of Internal Medicine, James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Karilyn Larkin
- Division of Hematology, Department of Internal Medicine, James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Samantha Jaglowski
- Division of Hematology, Department of Internal Medicine, James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Alice Mims
- Division of Hematology, Department of Internal Medicine, James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Sam Penza
- Division of Hematology, Department of Internal Medicine, James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Sumithira Vasu
- Division of Hematology, Department of Internal Medicine, James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Sarah A Wall
- Division of Hematology, Department of Internal Medicine, James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Basem William
- Division of Hematology, Department of Internal Medicine, James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Ayman Saad
- Division of Hematology, Department of Internal Medicine, James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Julianna V F Roddy
- Department of Pharmacy, James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Hannah Choe
- Division of Hematology, Department of Internal Medicine, James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Marcin Puto
- Department of Pharmacy, James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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