Hematology · 3 h ago
Fludarabine-Treosulfan Linked to Lower Relapse After ALL Transplant
A retrospective registry study of 967 adults with acute lymphoblastic leukemia compared fludarabine-treosulfan with fludarabine-melphalan conditioning before allogeneic transplantation. Treosulfan conditioning was associated with lower relapse incidence, but overall and leukemia-free survival did not differ significantly.
- Registry study compared two conditioning regimens in 967 adults with ALL.
- Flu/Treo was associated with lower relapse incidence.
- Overall and leukemia-free survival did not differ significantly.
- Prospective studies are needed to validate the findings.
This retrospective registry-based study included 967 adults with B- or T-cell acute lymphoblastic leukemia (ALL) who underwent a first allogeneic hematopoietic stem cell transplant in first or later complete remission between 2012 and 2024. Patients received fludarabine-melphalan (Flu/Mel; 778) or fludarabine-treosulfan (Flu/Treo; 189). The primary endpoint was leukemia-free survival; outcomes were assessed through two years, with multivariable models adjusting for clinical and transplant-related factors.
At two years, overall survival was 65.6% with Flu/Treo and 60.5% with Flu/Mel; leukemia-free survival was 57.2% and 49.7%, respectively. Neither difference was significant in adjusted analyses. Relapse incidence was 24.1% with Flu/Treo versus 31.5% with Flu/Mel; adjusted analysis associated Flu/Treo with lower relapse risk (hazard ratio 0.61; p=0.011). Non-relapse mortality was similar (18.6% vs 18.8%). Findings were similar in B-ALL, while no differences emerged in T-ALL.
The results suggest Flu/Treo may be an alternative conditioning regimen, particularly for B-ALL, but do not establish a survival advantage. Treatment groups differed in transplant characteristics, and the retrospective findings require prospective validation.
In practice
For adults with ALL undergoing a first allogeneic transplant, this retrospective comparison suggests fludarabine-treosulfan may reduce relapse relative to fludarabine-melphalan, with similar non-relapse mortality. The association was observed in B-ALL but not T-ALL. Because overall and leukemia-free survival were not significantly different, the groups differed in transplant characteristics, and the study was not prospective, these findings do not establish that clinicians should change conditioning selection; prospective validation is needed.
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Blood Advances: Fludarabine-treosulfan compared with fludarabine-melphalan conditioning for adult acute lymphoblastic leukemia. ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.