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Comparative Study
. 2025 Jun;21(15):1887-1894.
doi: 10.1080/14796694.2025.2507563. Epub 2025 May 28.

Busulfan-cyclophosphamide vs fludarabine-busulfan for allogeneic transplant in acute myeloid leukemia

Ben Abdeljelil N  1 , Kanoun R Y  1 , Mekni S  1 , Turki I  1 , Ben Yaiche I  1 , Ouerghi R  1 , Belloumi D  1 , Torjemane L  1 , Ladeb S  1 , Ben Othman T  1
Affiliations
Comparative Study

Busulfan-cyclophosphamide vs fludarabine-busulfan for allogeneic transplant in acute myeloid leukemia

Ben Abdeljelil N et al. Future Oncol. 2025 Jun.

Abstract

Background: Busulfan and cyclophosphamide (BuCy) is the standard myeloablative conditioning regimen for patients with acute myeloblastic leukemia (AML) undergoing allogeneic hematopoietic stem-cell transplantation (allo-HSCT). Fludarabine and busulfan (FluBu) conditioning seems to have similar efficacy with less toxicity.

Aims and methods: Descriptive retrospective study conducted on patients with AML who underwent geno-identical allo-HSCT between January 2011 and December 2022. Patients received a myeloablative conditioning with either BuCy2 orFluBu4. The objective was to compare the efficacy and safety of this regimens.

Results: A total of 113 adult patients were included. Conditioning regimen was BuCy2 in 81% of patients (n = 92) and FluBu4 in 19% of patients (n = 21). The 3-year estimated overall survival and event-free survival were 65% vs 81% (p = 0.19) and 58% vs 76% (p = 0.18) in BuCy2 and FluBu4 regimens, respectively. GVHD-Relapse Free Survival was better in FluBu4 group compared to BuCy2 group (28% vs 41%, p = 0.03). The Cumulative incidence of relapse and non-relapse mortality were 38% vs 14% (p = 0.17) and 15% vs 10% (p = 0.57) in BuCy2 and FluBu4, respectively. Both regimens yield comparable toxicities.

Conclusion: Myeloablative FluBu4 conditioning appeared to achieve clinical outcomes similar to BuCy2 and may be considered as a possible alternative for patients at high risk of NRM.

Keywords: Acute myeloid leukemia; allogeneic hematopoietic stem cell transplantation; busulfan; conditioning regimens; cyclophosphamide; fludarabine.

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Conflict of interest statement

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

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