• Hirotoshi Sakaguchi, Hideki Muramatsu, Daiichiro Hasegawa, Kazuko Kudo, Hiroyuki Ishida, Nao Yoshida, Katsuyoshi Koh, Maiko Noguchi, Norio Shiba, Sadao Tokimasa, Takhiro Fukuda, Hiroaki Goto, Takako Miyamura, Yozo Nakazawa, Yoshiko Hashii, Masami Inoue, Yoshiko Atsuta, and Pediatric AML Working Group of the Japan Society for Hematopoietic Cell Transplantation.
• Department of Hematology and Oncology, Children's Medical Center, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan.
• Pediatr Blood Cancer. 2019 Jan 1; 66 (1): e27459.

BackgroundIndications for hematopoietic stem cell transplantation (HSCT) have decreased with the improvement in chemotherapy for pediatric acute myeloid leukemia (AML) in the last decade. We conducted reevaluation of autologous HSCT (AHSCT) to compare myeloablative conditioning (MAC) regimens for pediatric AML without the need for consideration of toxicities caused by allogeneic immune reactions.ProcedureThis retrospective study analyzed the clinical outcomes of 220 children with AML who underwent consecutive AHSCT between 1989 and 2002 in Japan by the national prospective registry. The transplantation outcomes of various conditioning regimens were compared.ResultsThe median follow-up period of the survivors was 160 months. The clinical outcomes of busulfan + cyclophosphamide ± etoposide or busulfan + melphalan regimens were significantly superior compared with other busulfan-based and total body irradiation-based regimens (leukemia-free survival [LFS]: 68% vs 42% and 55%, P = 0.001; overall survival [OS]: 74% vs 49% and 61%, P < 0.001). Multivariate analysis showed that busulfan + cyclophosphamide ± etoposide and busulfan + melphalan regimens were independent favorable factors for LFS (hazard ratio: 0.46; P < 0.001) and OS (hazard ratio: 0.40; P < 0.001) compared with the other busulfan-based regimen, and both age 2 years or older and advanced stage at AHSCT were independent poor predictors for LFS and OS, simultaneously.ConclusionBusulfan + cyclophosphamide ± etoposide and busulfan + melphalan regimens exhibited superior antileukemic effects compared with other BU-based myeloablative regimens.© 2018 Wiley Periodicals, Inc.

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