What question did this study set out to answer?

To compare the efficacy and safety of fludarabine plus myeloablative busulfan (FluBu4) versus fludarabine plus high-dose melphalan (FluMel140) as conditioning regimens for allogeneic stem cell transplantation in malignant lymphoma.

March 15, 2025Biology of Blood and Marrow TransplantationOpen Access

Fludarabine Plus Myeloablative Dose of Busulfan Regimen Was Associated with High Nonrelapse Mortality in Allogeneic Hematopoietic Stem Cell Transplantation for Malignant Lymphoma: A Propensity Score-Matched Comparison Study with Fludarabine Plus High-Dose Melphalan

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Authors

ASAkihito ShinoharaTokyo Women's Medical University MSMichiho ShindoRIKEN Center for Integrative Medical Sciences SYSatoshi YamasakiSt Mary's Hospital

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Implication

Retrospective cohort study reveals increased nonrelapse mortality with fludarabine-busulfan versus fludarabine-melphalan in lymphoma, suggesting melphalan is safer.

Key Points

To compare the efficacy and safety of fludarabine plus myeloablative busulfan (FluBu4) versus fludarabine plus high-dose melphalan (FluMel140) as conditioning regimens for allogeneic stem cell transplantation in malignant lymphoma.
Retrospective analysis of Japanese national registry data from the Transplant Registry Unified Management Program for patients aged ≥16 years undergoing their first allogeneic hematopoietic stem cell transplantation for malignant lymphoma.
Applied 1:2 propensity score matching to select 113 patients in the FluBu4 group and 226 patients in the FluMel140 group, excluding cases treated with posttransplant cyclophosphamide.
Evaluated outcomes over a median observation period of 33.8 months among surviving patients (median cohort age: 54 years).
Three-year overall survival was significantly lower with FluBu4 compared to FluMel140 (28.0% vs. 48.6%; P < .01).
Three-year nonrelapse mortality was significantly higher with FluBu4 than FluMel140 (35.3% vs. 22.5%; P = .02), while 3-year relapse rates were 40.1% vs. 38.5% (P = .65).
One-year cumulative incidence of interstitial pneumonia was significantly increased in the FluBu4 cohort compared to the FluMel140 cohort (5.3% vs. 0.4%; P = .03), alongside higher rates of fatal noninfectious lung complications.

Cite This Study

Shinohara et al. (2025) studied this question.

synapsesocial.com/papers/6aa3d79d240321efda55583b https://doi.org/10.1016/j.jtct.2025.03.008

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Implication

Retrospective cohort study reveals increased nonrelapse mortality with fludarabine-busulfan versus fludarabine-melphalan in lymphoma, suggesting melphalan is safer.

Fludarabine Plus Myeloablative Dose of Busulfan Regimen Was Associated with High Nonrelapse Mortality in Allogeneic Hematopoietic Stem Cell Transplantation for Malignant Lymphoma: A Propensity Score-Matched Comparison Study with Fludarabine Plus High-Dose Melphalan

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Cite This Study

Fludarabine Plus Myeloablative Dose of Busulfan Regimen Was Associated with High Nonrelapse Mortality in Allogeneic Hematopoietic Stem Cell Transplantation for Malignant Lymphoma: A Propensity Score-Matched Comparison Study with Fludarabine Plus High-Dose Melphalan

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Cite This Study

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