FLAMSA vs BU-FLU in patients undergoing allogeneic stem cell transplantation for acute leukemia and myelodysplastic syndrome

Objective: Similar to other regimens, the specific role of fludarabine-amsacrine-cytarabine (FLAMSA) regimen before allogeneic transplantation has still unclear. We compared the results of patients who received either the FLAMSA regimen or the busulfan-fludarabine (BuFlu) regimen prior to allogeneic transplantation. Materials and Methods: Patients who underwent allogeneic transplantation and who administered reduced-intensity conditioning (RIC) regimens before transplantation were included in this study. Patients were divided into two groups (BuFlu and FLAMSA) according to the applied RIC regimens. Results: A total of 37 allogeneic transplant patients (13 FLAMSA, 24 BuFlu patients) were included in this study. The time between diagnosis and transplantation was shorter in the patients in the FLAMSA group compared to the patients in the BuFlu group (p<0.001). Although platelet engraftment time was shorter in the FLAMSA group than in the busulfan-fludarabine group (p=0.048), the neutrophil engraftment time and adverse events were similar in the two groups (all p>0.05). The estimated median disease-free survival of the patients in the FLAMSA group was 7.2 months, while it was 3.7 months in the busulfan-fludarabine group (p=0.778). Similarly, the estimated median overall survival of the patients in the FLAMSA group was 7.2 months, while 7 months in the BuFlu group (p=0.815). Conclusion: BuFlu and FLAMSA are two alternative conditioning regimen options that provide similar efficacy, toxicity profile and survival as regimens used in allogeneic transplantation. The FLAMSA regimen may be an alternative to Bu-Flu as a priming regimen for allogeneic stem cell transplantation. Meta-analyzes should be performed to evaluate with more patients.