A Retrospective Analysis of 344 Fludarabine Melphalan RIC Allogeneic Stem Cell Transplants for Myeloid and Lymphoid Malignancies In Australia and New Zealand 1998–2008,

Fludarabine Melphalan (FluMel) is the commonest Reduced Intensity Conditioning (RIC) regimen used in Australia and New Zealand. This study aims to assess the relative benefit of this regimen in both lymphoid and myeloid malignancies and to further delineate risk factors associated with an improved survival using RIC conditioning.

This was an ABMTRR based retrospective study assessing the outcome of FluMel RIC allografting in 9 Australian and New Zealand Centres between 1998 and 2008. Data was collected from centres using an excel based eCRF emailed to centres. Analysis was performed using Stata software and a p value less than 0.05 was considered significant.

Median follow up was 3.4 years. There were 342 patients with a median age of 54 years (18–68) and 61% were male. 234 patients had myeloid malignancies with AML (n=166) being the commonest indication whereas there were 110 lymphoid patients with NHL (n=64) the main indication. TRM at D100 was 14% with no significant difference between the groups. OS and DFS were similar between myeloid and lymphoid patients (50% and 43% at 5 years respectively). There was no difference in the cumulative incidence of relapse and GVHD between the groups. Multivariate analysis revealed 4 adverse risk factors for DFS: non-HLA identical sibling donor, not in remission at transplant, previous autologous transplant, and recipient CMV +ve. The presence of Chronic GVHD was associated with a better DFS predominantly due to a marked reduction in relapse (HR 0.44, p=0.003).

This is one of the largest analyses of Fludarabine Melphalan RIC transpants performed. This dataset confirms that FluMel provides durable remissions in both myeloid and lymphoid malignancies with 50% overall survival at 5 years. The multivariate analysis provides important clues for improving outcomes when planning FluMel conditioning in patients with haematological malignancies.

No relevant conflicts of interest to declare.