Cancer Institute A national cancer institute
designated cancer center

Ginna G. Laport

Publication Details

  • Prospective cohort study comparing intravenous busulfan to total body irradiation in hematopoietic cell transplantation BLOOD Bredeson, C., LeRademacher, J., Kato, K., DiPersio, J. F., Agura, E., Devine, S. M., Appelbaum, F. R., Tomblyn, M. R., Laport, G. G., Zhu, X., McCarthy, P. L., Ho, V. T., Cooke, K. R., Armstrong, E., Smith, A., Rizzo, J. D., Burkart, J. M., Pasquini, M. C. 2013; 122 (24): 3871-3878


    We conducted a prospective cohort study testing the noninferiority of survival of ablative intravenous busulfan (IV-BU) vs ablative total body irradiation (TBI)-based regimens in myeloid malignancies. A total of 1483 patients undergoing transplantation for myeloid malignancies (IV-BU, N = 1025; TBI, N = 458) were enrolled. Cohorts were similar with respect to age, gender, race, performance score, disease, and disease stage at transplantation. Most patients had acute myeloid leukemia (68% IV-BU, 78% TBI). Grafts were primarily peripheral blood (77%) from HLA-matched siblings (40%) or well-matched unrelated donors (48%). Two-year probabilities of survival (95% confidence interval [CI]), were 56% (95% CI, 53%-60%) and 48% (95% CI, 43%-54%, P = .019) for IV-BU (relative risk, 0.82; 95% CI, 0.68-0.98, P = .03) and TBI, respectively. Corresponding incidences of transplant-related mortality (TRM) were 18% (95% CI, 16%-21%) and 19% (95% CI, 15%-23%, P = .75) and disease progression were 34% (95% CI, 31%-37%) and 39% (95% CI, 34%-44%, P = .08). The incidence of hepatic veno-occlusive disease (VOD) was 5% for IV-BU and 1% with TBI (P < .001). There were no differences in progression-free survival and graft-versus-host disease. Compared with TBI, IV-BU resulted in superior survival with no increased risk for relapse or TRM. These results support the use of myeloablative IV-BU vs TBI-based conditioning regimens for treatment of myeloid malignancies.

    View details for DOI 10.1182/blood-2013-08-519009

    View details for Web of Science ID 000329737600010

    View details for PubMedID 24081656

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