Long-term outcomes in patients with high-risk myeloid malignancies following matched related donor hematopoietic cell transplantation with myeloablative conditioning of BU, etoposide and CY

Patients with high-risk or advanced myeloid malignancies have limited effective treatment options. These include high-dose therapy followed by allogeneic hematopoietic cell transplantation (HCT). We report a single-institution, long-term follow-up of 96 patients, median age 50 (range, 20–60) years, who received HLA-matched related HCT between 1992 and 2007. All patients were treated with a uniform preparatory regimen intended to enhance the widely used regimen of BU and CY that included: BU 16.0 mg/kg (days −8 to −5), etoposide 60 mg/kg (day −4), CY 60 mg/kg (day −2) with GVHD prophylaxis of CsA or FK506 and prednisone. Disease status at transplantation was high-risk AML ( n =41), CML in second chronic phase or blast crisis ( n =8), myelofibrosis and myeloproliferative disorders ( n =8), and myelodysplasia ( n =39). Thirty-six percent ( n =35) of patients received BM whereas 64% ( n =61) received G-CSF-mobilized PBPC. With a median follow-up of 5.6 years (range, 1.6–14.6 years) actuarial 5-year OS was 32% (95% CI 22–42) and 5-year EFS was 31% (95% CI 21–41). Relapse rate was 24% (95% CI 15–33) at 2 and 5 years. Nonrelapse mortality was 29% (95% CI 20–38) at day 100 and 38% (95% CI 29–47) at 1 year. Cumulative incidence of acute (grade II–IV) and extensive chronic GVHD was 27% (95% CI 18–36) and 29% (95% CI 18–40), respectively. There was no statistically significant difference in OS (31 vs 32%, P =0.89) or relapse rates (17 vs 28%, P =0.22) for recipients of BM vs PBPC, respectively. These results confirm that patients with high-risk or advanced myeloid malignancies can achieve long-term survival following myeloablative allogeneic HCT with aggressive conditioning.