Survival advantage of treosulfan plus fludarabine (FT14) compared to busulfan plus fludarabine (FB4) in active acute myeloid leukemia post allogeneic transplantation: an analysis from the European Society for Blood and Marrow Transplantation (EBMT) Acute Leukemia Working Party (ALWP)

Research output: Contribution to journalResearch articleContributedpeer-review


  • Eleni Gavriilaki - , G Papanikolaou Hospital (Author)
  • Ioanna Sakellari - , G Papanikolaou Hospital (Author)
  • Myriam Labopin - , Saint-Antoine Hospital - Sorbonne Université (Author)
  • Martin Bornhäuser - , University Cancer Centre, Department of internal Medicine I (Author)
  • Rose-Marie Hamladji - , Quinze-Vingts National Ophthalmology Hospital (Author)
  • Jochen Casper - , Klinikum Oldenburg (Author)
  • Matthias Edinger - , University Children's Hospital Regensburg (KUNO) (Author)
  • Pavel Zák - , University Hospital Motol (Author)
  • Ibrahim Yakoub-Agha - , CHU de Lille (Author)
  • Fabio Ciceri - , IRCCS Hospital San Raffaele (Author)
  • Thomas Schroeder - , University Hospital Dept. of Bone Marrow Transplantation (Author)
  • Tsila Zuckerman - , Rambam Medical Center (Author)
  • Guido Kobbe - , Heinrich Heine University Düsseldorf (Author)
  • Moshe Yeshurun - , Beilinson Hospital (Author)
  • Franco Narni - , Azienda Ospedaliero Universitaria di Modena Policlinico (Author)
  • Jürgen Finke - , University Medical Center Freiburg (Author)
  • Jose Luiz Diez-Martin - , Hospital General Universitario Gregorio Marañon (Author)
  • Ana Berceanu - , Hôpital Jean Minjoz (Author)
  • Inken Hilgendorf - , Jena University Hospital (Author)
  • Mareike Verbeek - , Klinikum Rechts der Isar (MRI TUM) (Author)
  • Attilio Olivieri - , Ancona University (Author)
  • Bipin Savani - , Vanderbilt University (Author)
  • Alexandros Spyridonidis - , University Hospital of Patras (Author)
  • Arnon Nagler - , Chaim Sheba Medical Center (Author)
  • Mohamad Mohty - , Saint-Antoine Hospital - Sorbonne Université (Author)


We compared FT14 (fludarabine 150-160 mg/m2, treosulfan 42 g/m2) versus FB4 (fludarabine 150-160 mg/m2, busulfan 12.8 mg/kg) in acute myeloid leukemia (AML) transplanted at primary refractory/relapsed disease. We retrospectively studied: (a) adults diagnosed with AML, (b) recipients of first allogeneic hematopoietic stem cell transplantation (HSCT) from unrelated/sibling donor (2010-2020), (c) HSCT with primary refractory/relapsed disease, (d) conditioning regimen with FT14 or FB4. We studied 346 patients, 113 transplanted with FT14, and 233 with FΒ4. FT14 patients were significantly older, more frequently had an unrelated donor and had received a lower dose of fludarabine. Cumulative incidence (CI) of acute graft-versus-host disease (GVHD) grade III-IV and extensive chronic GVHD was similar. With a median follow-up of 28.7 months, 2-year CI of relapse was 43.4% in FT14 versus 53.2% in FB4, while non-relapse mortality (NRM) was respectively 20.8% versus 22.6%. This led to 2-year leukemia-free survival (LFS) of 35.8% for FT14 versus 24.2% in FB4, and overall survival (OS) of 44.4% versus 34%. Adverse cytogenetics and conditioning regimen independently predicted CI of relapse. Furthermore, conditioning regimen was the only independent predictor of LFS, OS, and GVHD-free/relapse-free survival. Therefore, our real-world multicenter study suggests that FT14 is associated with better outcomes in primary refractory/relapsed AML.


Original languageEnglish
Pages (from-to)1084-1088
Number of pages5
JournalBone marrow transplantation
Issue number10
Publication statusPublished - Oct 2023

External IDs

Scopus 85164172757