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  • Title: Intravenous BU plus Mel: an effective, chemotherapy-only transplant conditioning regimen in patients with ALL.
    Author: Kebriaei P, Madden T, Wang X, Thall PF, Ledesma C, de Lima M, Shpall EJ, Hosing C, Qazilbash M, Popat U, Alousi A, Nieto Y, Champlin RE, Jones RB, Andersson BS.
    Journal: Bone Marrow Transplant; 2013 Jan; 48(1):26-31. PubMed ID: 22732703.
    Abstract:
    We investigated the administration of i.v. BU combined with melphalan (Mel) in patients with ALL undergoing allogeneic hematopoietic SCT. Forty-seven patients with a median age of 33 years (range 20-61) received a matched sibling (n=27) or matched unrelated donor transplant (n=20) for ALL in first CR (n=26), second CR (n=13), or with more advanced disease (n=8). BU was infused daily for 4 days, either at a fixed dose of 130 mg/m² (5 patients) or using pharmacokinetic (PK) dose adjustment (42 patients), to target an average daily area-under-the-curve (AUC) of 5000 μmol/min, determined by a test dose of i.v. BU at 32 mg/m². This was followed by a rest day, then two daily doses of Mel at 70 mg/m². Stem cells were infused on the following day. The 2-year OS, PFS and non-relapse mortality (NRM) rates were 35% (95% confidence interval (CI), 23-51%), 31% (95% CI, 21-48%) and 37% (95% CI, 23-50%), respectively. Acute NRM at 100 days was favorable at 12% (95% CI, 5-24%); however, the 2-year NRM was significantly higher for patients older than 40 years, 58% vs 20%, mainly due to GVHD.
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