Autologous stem cell transplantation for adult acute myelocytic leukemia in first remission—Better outcomes after busulfan and melphalan compared with busulfan and cyclophosphamide: A retrospective study from the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation (EBMT)

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Abstract
BACKGROUND: Autologous stem cell transplantation (ASCT) for adult acute myelogenous leukemia (AML) is a valid therapeutic option for patients with good‐risk and intermediate‐risk disease. The authors used the registry of the European Society for Blood and Marrow Transplantation to compare combined busulfan and melphalan (BUMEL) with combined busulfan and cyclophosphamide (BUCY) before transplantation.METHODS: From 2005 to 2013, 853 patients with available cytogenetics underwent ASCT in first remission, including 257 after receiving BUMEL and 596 after receiving BUCY. The proportion of patients with good‐risk AML was lower in those who received BUMEL (14% vs 20%;P = .02). More patients who received BUMEL underwent autograft in molecular remission (89% vs 78%;P = .02). Three years after transplantation, the relapse incidence (RI) was 48.7%, the leukemia‐free survival (LFS) rate was 47.7%, the overall survival (OS) rate was 66.2%, and the nonrelapse mortality (NRM) rate was 3.6%.RESULTS: Patients who underwent an autograft after receiving BUMEL fared better than those who underwent an autograft after receiving BUCY with a lower RI (39.5% vs 52.2%; hazard ratio [HR], 0.65; 95% confidence interval [CI], 0.49‐0.87;P = .003) a better LFS (55.4% vs 44.6%; HR, 0.69; 95% CI, 0.53‐0.89;P = .005), and a better OS (73.8% vs 63%; HR, 0.62; 95% CI, 0.47‐0.82;P = .0007). There was no difference in the NRM rate (BUMEL vs BUCY, 4.5% vs 3.2%, respectively). Among 74 patients in the BUMEL group and 187 in the BUCY group who underwent autograft in molecular remission, the RI was 30% versus 51%, respectively (univariate analysis;P = .01), and the LFS rate was 66% versus 47%, respectively (univariate analysis;P = .03).CONCLUSIONS: In patients with AML in first complete remission who undergo ASCT, the BUMEL combination is a better preparative regimen.Cancer2017;123:824–31.©2016 American Cancer Society.

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