Outcomes of BuCy and BuCyMel conditioning in infant AML
Willasch AM, Horgan C, Peters C, et al. Comparison of Outcomes of BuCy Versus BuCyMel as Preparation for Allogeneic HSCT in Infants With Acute Myeloid Leukemia in First Complete Remission: A Multicenter Study From the EBMT PDWP. Bone Marrow Transplantation. 2025; (doi: 10.1038/s41409-025-02734-8).
Based on a study of the youngest allogeneic hematopoietic stem cell transplant (allo-HSCT) recipients, the myeloablative conditioning regimen BuCy (bulsulfan and cyclophosphamide) is more effective when melphalan is added. Members of a working group of the European Society for Blood and Marrow Transplant pulled data from the multinational registry on children aged 2 years and younger who received transplants for acute myeloid leukemia (AML) between 2000 and 2022. Among 335 patients included in the investigation, 185 underwent BuCy conditioning and 150 underwent BuCyMel. Outcomes favored the BuCyMel regimen, which yielded a 4-year leukemia-free survival rate of 74.8% vs. 58.8% in the BuCy treatment arm and 4-year overall survival of 77.9% vs. 66.2%. BuCyMel also was associated with a significantly lower relapse rate compared with BUCY, but the risk of 4-year non-relapse mortality was similar between the two groups.