Myeloablative conditioning with busulfan and fludarabine (bu/flu) may produce similar clinical outcomes and quality of life (QOL) compared with conditioning with busulfan and cyclophosphamide (bu/cy) for allogeneic hematopoietic cell transplantation (alloHCT) in acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS), according to research published in Hematology/Oncology and Stem Cell Therapy.

Although bu/cy and bu/flu are both standard myeloablative conditioning regimens for alloHCT, they have not yet been studied with a focus on quality of life. Researchers conducted a single center, retrospective analysis of adult patients who received a first T-cell-replete human leukocyte antigen-8/8 matched related or unrelated donor alloHCT. The study included 126 patients with AML and 84 patients with MDS. All patients were 18 years or older and were treated between 2008 and 2017.

Quality of life was measured using the Functional Assessment of Cancer Therapy-Bone Marrow Transplant Scale (FACT-BMT) questionnaire.

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The researchers found no significant differences in FACT-BMT scores between patients receiving bu/cy and patients receiving bu/flu in both the AML and MDS cohorts. No significant difference was found to for mucositis severity either.

When patients with AML were analyzed separately, the researchers found that those receiving bu/flu had more rapid neutrophil and platelet recovery compared with patients receiving bu/cy, as well as a shorter median hospital stay. No differences were found in other post-transplant outcomes.

In the MDS cohort, the researchers found that patients receiving bu/flu had more rapid platelet recovery and a shorter median hospital stay as well as greater risk for cytomegalovirus infection compared with patients receiving bu/cy. However, patients receiving bu/flu experienced decreased risk for nonrelapse mortality. There were no significant differences in other outcomes.

Previous studies examining these 2 regimens have found no differences regarding hematopoietic engraftment kinetics, risk for grade 3 or 4 mucositis, graft-versus-host disease, relapse, and nonrelapse mortality. The current study suggests quality of life may also be similar between the regimens. “Future formal cost-effectiveness analyses of these regimens would be appropriate to better assess the implications for resource utilization,” wrote the authors.


  1. Patel SS, Rybicki L, Pohlman B, et al. Comparative effectiveness of busulfan/cyclophosphamide versus busulfan/fludarabine myeloablative conditioning for allogeneic hematopoietic cell transplantation in acute myeloid leukemia and myelodysplastic syndrome [published online October 11, 2019]. doi:10.1016/j.hemonc.2019.09.002

This article originally appeared on Hematology Advisor