Although the combination of fludarabine and high-dose melphalan (FLU/MEL) has been widely used in allogeneic stem cell transplantation, high-dose MEL causes life-threatening adverse events, especially in elderly patients. To reduce the toxicity of MEL without losing its antileukemic effect, we formulated a regimen comprising FLU (125 mg/m2), MEL (100 mg/m2), and a non-myeloablative busulfan dosage [4 mg/kg orally (oral) or 3.2 mg/kg intravenously (iv); FLU/MEL/BU]. We retrospectively analyzed 32 patients with myeloid malignancies who received FLU/MEL/BU at our institute. Median age was 59 years and the median observation period after allo-SCT was 8.2 years. The disease status of most of the patients (97%) at transplantation was controlled. The rate of neutrophil engraftment was 93.3%. The 5-year overall survival (OS), disease-free survival (DFS), non-relapse mortality (NRM), and relapse rate (RR) were 68.5%, 62.1%, 22.0%, and 15.9%, respectively, in all patients. Notably, the outcome of FLU/MEL/iv BU was excellent, with the 5-year OS and DFS being 75.6% and 70.8%, respectively, accompanied by a reduced 5-year NRM and RR of 19.3% and 9.8%, respectively. In conclusion, FLU/MEL/BU, particularly FLU/MEL/iv BU, has curative potential for controlled myeloid malignancies.

中文翻译：

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氟达拉滨，美法仑和白消安非清髓性剂量在老年髓样恶性肿瘤患者中的治疗潜力。

尽管氟达拉滨和高剂量美法仑（FLU / MEL）的组合已广泛用于同种异体干细胞移植，但高剂量MEL会危及生命，尤其是在老年患者中。为了降低MEL的毒性而又不丧失其抗白血病作用，我们制定了包括FLU（125 mg / m2），MEL（100 mg / m2）和非清髓性白消安剂量[4 mg / kg口服（口服）或静脉注射3.2 mg / kg（iv）；FLU / MEL / BU]。我们回顾性分析了我院接受FLU / MEL / BU治疗的32例髓样恶性肿瘤患者。中位年龄为59岁，异基因SCT后的中位观察期为8.2年。大多数患者（97％）在移植时的疾病状况得到控制。中性粒细胞的植入率为93.3％。5年总生存期（OS），无病生存期（DFS），所有患者的非复发死亡率（NRM）和复发率（RR）分别为68.5％，62.1％，22.0％和15.9％。值得注意的是，FLU / MEL / iv BU的效果非常好，5年OS和DFS分别为75.6％和70.8％，同时5年NRM和RR分别降低了19.3％和9.8％。总之，FLU / MEL / BU，尤其是FLU / MEL / iv BU，对控制髓样恶性肿瘤具有治愈潜力。