AUTHOR=Li Ziying , Shi Wei , Lu Xuan , Lu Hui , Cao Xiena , Tang Liang , Yan Han , Zhong Zhaodong , You Yong , Xia Linghui , Hu Yu , Wang Huafang 

TITLE=Decitabine-Intensified Modified Busulfan/Cyclophosphamide Conditioning Regimen Improves Survival in Acute Myeloid Leukemia Patients Undergoing Related Donor Hematopoietic Stem Cell Transplantation: A Propensity Score Matched Analysis

JOURNAL=Frontiers in Oncology

VOLUME=Volume 12 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2022.844937

DOI=10.3389/fonc.2022.844937

ISSN=2234-943X

ABSTRACT=To identify the benefit of decitabine (Dec) intensified myeloblative conditioning on the outcomes of patients with acute myeloid leukemia (AML) after related donor hematopoietic stem cell transplantation (HSCT), we performed a retrospective matched‐pair study from a pool of 156 patients to evaluate Dec (20 mg/m2/d i.v. on days −11 to −7) intensified modified busulfan/cyclophosphamide (mBuCy) conditioning regimen versus mBuCy regimen in 92 AML patients, with 46 patients in each cohort. The cumulative incidence of grade II -IV acute graft-versus-host disease (aGVHD) was lower in the Dec group (15.2%±0.3% vs. 32.6%±0.5%, P=0.033). Compared with mBuCy group (15.5%±0.3%), a significant higher proportion of limited cGVHD in Dec group (35%±0.6%) was observed (P =0.025). Dec-intensified mBuCy conditioning was associated with better 2-year overall survival (OS) and GVHD-free relapse-free survival (GRFS) (81%±6.2% vs. 59.4%±7.5%, P = 0.03; 58.7%±8.1% vs. 40.9%±7.3%, P = 0.042; respectively). Our results also elucidated that the Dec group had better 2-year OS and lower 2-year cumulative incidence of relapse (CIR) in patients acquiring haploidentical HSCT than that of the mBuCy group (84.8%±7.1% vs. 58.2%±10.3%, P = 0.047; 17.9%±0.8% vs. 40.0%±1.0%, P = 0.036; respectively), which didn’t increase the treatment related mortality and regimens associated toxicities. Dec intensified myeloblative regimen and high-risk stratification were the vibrable associated with OS, leukemia-free survival (LFS) and GRFS in multivariate analysis. In high-risk patients, no differences were found in CIR, OS, LFS and GRFS between the two groups. These data indicated that Dec-intensified mBuCy conditioning regimen was associated with better survival than mBuCy regimen in AML patients, especially in patients undergoing haploidentical HSCT.