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October 12, 2025

Optimal conditioning intensity: favorable outcome of a 3-day busulfan based regimen in younger acute myeloid leukemia patients

Key Points

A 3-day busulfan regimen resulted in better overall survival rates among younger AML patients undergoing HCT, indicating its efficacy.
Overall survival improved significantly with Bu3 compared to 2-day and 4-day regimens, with a p-value of less than 0.001.
Multivariate analysis confirmed the OS benefit of Bu3 with a hazard ratio of 0.513, reinforcing its role as the preferred conditioning regimen.
Despite lower relapse rates with Bu4, event-free survival was akin to Bu3, suggesting no added advantage in more intensive regimens.

Abstract

Myeloablative conditioning is standard for younger acute myeloid leukemia (AML) patients undergoing allogeneic hematopoietic cell transplantation (HCT), but optimal busulfan dosing remains unclear. We retrospectively analyzed 686 AML patients aged <55 years who received busulfan-based conditioning (2, 3, or 4 days) for first HCT at Asan Medical Center between 2000 and 2020. A 3-day course of busulfan (Bu3) showed significantly better overall survival (OS, p < 0.001) and lower non-relapse mortality (p = 0.005) compared to Bu2 and Bu4. Although Bu4 had the lowest relapse rate (p < 0.001), event-free survival was similar to Bu3. In multivariate analysis, only Bu3 maintained an OS benefit (hazard ratio 0.513, p = 0.016). Graft-versus-host disease-free, relapse-free survival did not differ among groups. Among patients in complete remission, Bu3 also showed a significant OS advantage (p = 0.040), while higher busulfan doses did not improve survival in refractory cases. These findings support Bu3 as the optimal conditioning regimen in younger AML patients undergoing HCT.

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Cite This Study

Park et al. (Fri,) studied this question.

synapsesocial.com/papers/68eb8fe250220ac955d94c4e https://doi.org/https://doi.org/10.1080/10428194.2025.2560086

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