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Conditioning Regimens

Fludarabine and busulfan as a myeloablative conditioning regimen for allogeneic stem cell transplantation in high- and standard-risk leukemic patients

Bone Marrow Transplantation volume 40, pages 105–110 (2007)Cite this article

Abstract

Busulfan and cyclophosphamide (BuCy) are currently the most widely used myeloablative regimen to treat malignancies with allogeneic stem cell transplantation. Fludarabine has considerable efficacy in both immunosuppression and tumor cells killing with a minimal extramedullary toxicity. We evaluated the efficacy of 40 mg/m2 fludarabine i.v. for 5 days and busulfan 4 mg/kg/day p.o. for 4 days as myeloablative conditioning regimen in 70 patients (median age 24 years) with acute leukemia or chronic phase of myelogenous leukemia. They all had human leukocyte antigen-matched sibling donors. The patients received 10 μg/kg granulocyte colony stimulating factor (GCSF), 24 h after stem cell infusion until engraftment occurred. Graft-versus-host disease (GVHD) prophylaxis included 3 mg/kg cyclosporine-A i.v. from day −2 to +6 followed by 12 mg/kg p.o. until day +60. The median time of neutrophil recovery (>0.5 × 109/l) and platelet recovery (>20 × 109/l) were 10 and 12 days, respectively. Mucositis (93%) and hepatic toxicity (16%) resolved with conservative therapy. The incidence of acute GVHD grade I-II and III-IV were 38.6 and 15.7% respectively. Overall survival and disease-free survival were 71 and 64% respectively with 17 months median follow-up for surviving patients. We conclude that FluBu may be used as a substitute for BuCy with almost the same efficacy and with a lower transplant adverse effect but to increase anti-leukemic effects, especially in acute lymphoblastic leukemia patients, it needs some modifications.

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Acknowledgements

This research has been supported by Hematology- Oncology and Bone Marrow Transplantation / Tehran University of Medical Sciences grant.

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  1. Hematology-Oncology and BMT Research Center, Medical Sciences, University of Tehran, Tehran, Iran

    M Iravani, M R Evazi, S A Mousavi, A R Shamshiri, M Tavakoli, A Ashouri, S Samiee, B Chahardovali, K Alimoghaddam, S H Ghaffari & A Ghavamzadeh

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  1. M Iravani
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Correspondence to A R Shamshiri.

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Iravani, M., Evazi, M., Mousavi, S. et al. Fludarabine and busulfan as a myeloablative conditioning regimen for allogeneic stem cell transplantation in high- and standard-risk leukemic patients. Bone Marrow Transplant 40, 105–110 (2007). https://doi.org/10.1038/sj.bmt.1705685

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