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Busulfan Fludarabine and Melphalan is effective conditioning for pediatric and young adult patients with myeloid malignancies underdoing matched sibling or alternative donor transplantation
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  • Emmanuel Katsanis,
  • Laurel Truscott,
  • Holly Pariury,
  • Santosh Hanmod,
  • Monica Davini,
  • Michelina de la Maza,
  • Lauren Sapp, MSN, CPNP,
  • Kyleigh Staples,
  • Maria Proytcheva
Emmanuel Katsanis
The University of Arizona

Corresponding Author:[email protected]

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Laurel Truscott
The University of Arizona
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Holly Pariury
The University of Arizona
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Santosh Hanmod
The University of Arizona
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Monica Davini
The University of Arizona
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Michelina de la Maza
The University of Arizona
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Lauren Sapp, MSN, CPNP
The University of Arizona
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Kyleigh Staples
The University of Arizona
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Maria Proytcheva
The University of Arizona
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Abstract

Background: Allogeneic hematopoietic cell transplantation (allo-HCT) remains a curative option for patients with high-risk myeloid malignancies. Procedure: We present our ten-year experience (October 2012-October 2021) of consecutive allo-HCT in patients with myeloid malignancies treated on the pediatric HCT service and conditioned with myeloablative targeted dose-busulfan (BU), fludarabine (FLU) and melphalan (MEL). Twenty-three children, adolescents, and young adult patients (CAYA) (median age 15.4yr) with acute myeloid leukemia (AML, n=17), myelodysplastic syndrome (MDS, n=4), or chronic myeloid leukemia (CML, n=2) underwent allo-HCT post-BU-FLU-MEL. Four patients had treatment-related AML/MDS. Donor/stem cell source was MSD PBSC (n=7), MUD PBSC (n=2), UCB (n=3) or haploidentical-BMT (n=11). Risk stratification was low (n=2), intermediate (n=15), high (=3) and very high risk (n=1). The two patients with CML had failed tyrosine kinase inhibitor therapies. Results: With a median follow-up of 39.6 months the relapse rate is only 4.5% with an OS 100%, PFS 95.5% and graft-versus-host-free-relapse-free survival (GRFS) 67.8%. The donor source and the GvHD prophylaxis regimen significantly impacted grades II-IV aGvHD 66.7% versus 19.2% ( P=0.039) and cGvHD 66.7% versus 0% ( P=0.002) in the patients receiving matched sibling (MSD) or matched unrelated donor (MUD) PBSC compared to haplo-BMT respectively, resulting in improved GRFS in haplo-BMT, 83.3% compared to 40% matched donor PBSCT ( P=0.025). Conclusions: Our results demonstrate that BU-FLU-MEL is efficacious conditioning for disease control in young patients with myeloid malignancies undergoing MSD or alternative donor allo-HCT but in the setting of PBSC grafts with CSA-MTX GvHD prophylaxis it results in an unacceptably high incidence of GvHD.
27 Jun 2022Submission Checks Completed
27 Jun 2022Assigned to Editor
27 Jun 2022Submitted to Pediatric Blood & Cancer
14 Sep 2022Reviewer(s) Assigned
06 Oct 2022Review(s) Completed, Editorial Evaluation Pending
10 Oct 2022Editorial Decision: Revise Minor
12 Oct 2022Submission Checks Completed
12 Oct 2022Assigned to Editor
12 Oct 20221st Revision Received
13 Oct 2022Review(s) Completed, Editorial Evaluation Pending
13 Oct 2022Reviewer(s) Assigned
24 Oct 2022Editorial Decision: Accept