Treosulfan compared with <scp>reduced‐intensity</scp> busulfan improves allogeneic hematopoietic cell transplantation outcomes of older acute myeloid leukemia and myelodysplastic syndrome patients: Final analysis of a prospective randomized trial
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- Dietrich W. Beelen
- Department of Bone Marrow Transplantation, West German Cancer Center University of Duisburg‐Essen Essen Germany
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- Matthias Stelljes
- Department of Medicine A/Hematology and Oncology University of Muenster Muenster Germany
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- Péter Reményi
- St. István and St. László Hospital of Budapest Budapest Hungary
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- Eva‐Maria Wagner‐Drouet
- 3rd Department of Medicine‐Hematology, Internal Oncology and Pneumology Johannes Gutenberg University Medical Centre Mainz Germany
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- Peter Dreger
- Department of Medicine V University of Heidelberg Heidelberg Germany
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- Wolfgang Bethge
- Department of Hematology and Oncology Medical Centre University Hospital Tuebingen Tuebingen Germany
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- Fabio Ciceri
- Hematology and Bone Marrow Transplantation Unit, Scientific Institute for Research Hospitalization and Health Care San Raffaele Milan Italy
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- Friedrich Stölzel
- Department of Internal Medicine, University Hospital Carl Gustav Carus Technical University Dresden Dresden Germany
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- Christian Junghanß
- Department of Hematology, Oncology, and Palliative Care University Medical Centre, University of Rostock Rostock Germany
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- Hélène Labussiere‐Wallet
- Department of Hematology, Centre Hospitalier Lyon‐Sud Hospices Civil de Lyon Lyon France
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- Kerstin Schaefer‐Eckart
- Clinicum Nuremberg Paracelsus Medical Private University Nuremberg Germany
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- Goetz U. Grigoleit
- University Clinic Wuerzburg Wuerzburg Germany
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- Christof Scheid
- Department of Internal Medicine University Hospital of Cologne Cologne Germany
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- Francesca Patriarca
- Hematological Clinic, Unit of Cellular Therapy ‘Carlo Melzi’ University Hospital Udine Italy
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- Alessandro Rambaldi
- Department of Oncology‐Hematology University of Milan and Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII Bergamo Italy
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- Dietger Niederwieser
- University Clinic Leipzig Leipzig Germany
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- Inken Hilgendorf
- Universitätsklinikum Jena, Klinik für Innere Medizin II Abteilung für Hämatologie und Onkologie Jena Germany
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- Domenico Russo
- Unit of Blood Diseases and Stem Cell Transplantation, Department of Clinical and Experimental Sciences University of Brescia, ASST, Spedali Civili of Brescia Brescia Italy
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- Gérard Socié
- Hospital Saint‐Louis Paris France
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- Ernst Holler
- University Medical Centre, University of Regensburg Department of Internal Medicine Regensburg Germany
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- Bertram Glass
- Asklepios Clinic Hamburg GmbH Hamburg Germany
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- Jochen Casper
- Department of Oncology and Hematology Clinic Oldenburg AöR Oldenburg Germany
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- Gerald Wulf
- University Medicine Goettingen, Georg‐August‐University Goettingen Germany
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- Nadezda Basara
- Malteser Hospital St. Franziskus‐Hospital Flensburg Germany
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- Maria Bieniaszewska
- Department of Hematology and Transplantology Medical University of Gdańsk Gdańsk Poland
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- Gernot Stuhler
- German Clinic for Diagnostics Helios Clinic Wiesbaden Germany
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- Mareike Verbeek
- Clinic and Policlinic for Internal Medicine III, Klinikum Rechts der Isar Technical University of Munich, School of Medicine Munich Germany
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- Ursula La Rocca
- Policlinic Umberto University La Sapienza Rome Italy
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- Jürgen Finke
- University Clinic Freiburg Medical Clinic Freiburg Germany
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- Fabio Benedetti
- Policlinic G.B. Rossi Borgo Rome Verona Italy
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- Uwe Pichlmeier
- Medac GmbH Wedel Germany
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- Anja Klein
- Medac GmbH Wedel Germany
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- Joachim Baumgart
- Medac GmbH Wedel Germany
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- Miroslaw Markiewicz
- Department of Hematology and Bone Marrow Transplantation A. Mielęcki Independent Public Clinical Hospital Katowice Poland
抄録
<jats:title>Abstract</jats:title><jats:p>The phase III study was designed to compare event‐free survival (EFS) after treosulfan‐based conditioning with a widely applied reduced‐intensity conditioning (RIC) busulfan regimen in older or comorbid patients with acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS) undergoing allogeneic hematopoietic cell transplantation (HCT). A previously reported confirmatory interim analysis of the randomized clinical study including 476 patients demonstrated statistically significant noninferiority for treosulfan with clinically meaningful improvement in EFS. Here, the final study results and pre‐specified subgroup analyses of all 570 randomized patients with completed longer‐term follow‐up are presented. Patients presenting HCT‐specific comorbidity index >2 or aged ≥50 years were randomly assigned (1:1) to intravenous (IV) fludarabine with either treosulfan (30 g/m<jats:sup>2</jats:sup> IV) or busulfan (6.4 mg/kg IV) after stratification by disease risk group, donor type, and participating institution. The primary endpoint was EFS with disease recurrence, graft failure, or death from any cause as events. EFS of patients (median age 60 years) was superior after treosulfan compared to RIC busulfan: 36‐months‐EFS rate 59.5% (95% CI, 52.2–66.1) vs. 49.7% (95% CI, 43.3–55.7) with a hazard ratio (HR) of 0.64 (95% CI, 0.49–0.84), <jats:italic>p</jats:italic> = 0.0006. Likewise, overall survival (OS) with treosulfan was superior compared to busulfan: 36‐month‐OS rate 66.8% vs. 56.3%; HR 0.64 (95% CI, 0.48–0.87), <jats:italic>p</jats:italic> = 0.0037. Post hoc analyses revealed that these differences were consistent with the confirmatory interim analysis, and thereby the treosulfan regimen appears particularly suitable for older AML and MDS patients.</jats:p>
収録刊行物
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- American Journal of Hematology
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American Journal of Hematology 97 (8), 1023-1034, 2022-06-08
Wiley