{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T15:33:42Z","timestamp":1781192022809,"version":"3.54.1"},"reference-count":33,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2022,11,17]],"date-time":"2022-11-17T00:00:00Z","timestamp":1668643200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Blood &amp; Cancer"],"published-print":{"date-parts":[[2023,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Allogeneic hematopoietic cell transplantation (allo\u2010HCT) remains a curative option for patients with high\u2010risk myeloid malignancies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Procedure<\/jats:title><jats:p>We present our 10\u2010year experience (October 2012 to October 2021) of consecutive allo\u2010HCT in patients with myeloid malignancies treated on the pediatric HCT service and conditioned with myeloablative targeted dose\u2014busulfan (BU), fludarabine (FLU), and melphalan (MEL). Twenty\u2010three children, adolescents, and young adult patients (CAYA) (median age 15.4\u00a0years) with acute myeloid leukemia (AML, <jats:italic>n<\/jats:italic> = 17), myelodysplastic syndrome (MDS, <jats:italic>n<\/jats:italic> = 4), or chronic myeloid leukemia (CML, <jats:italic>n<\/jats:italic> = 2) underwent allo\u2010HCT post\u2010BU\u2010FLU\u2010MEL. Four patients had treatment\u2010related AML\/MDS. Donor\/stem cell source was matched sibling donor (MSD) PBSC (<jats:italic>n<\/jats:italic> = 7), matched unrelated donor (MUD) PBSC (<jats:italic>n<\/jats:italic> = 2), umbilical cord blood (UCB) (<jats:italic>n<\/jats:italic> = 3), or haploidentical\u2010BMT (<jats:italic>n<\/jats:italic> = 11). Risk stratification was low (<jats:italic>n<\/jats:italic> = 2), intermediate (<jats:italic>n<\/jats:italic> = 15), high (<jats:italic>n<\/jats:italic> = 3), and very high risk (<jats:italic>n<\/jats:italic> = 1). The two patients with CML had failed tyrosine kinase inhibitor therapies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>With a median follow\u2010up of 41.6\u00a0months, the relapse rate is only 4.5% with an overall survival (OS) 100%, progression\u2010free survival (PFS) 95.5%, and graft\u2010versus\u2010host\u2010free\u2010relapse\u2010free survival (GRFS) 67.8%. The donor source and the acute graft\u2010versus\u2010host disease (GvHD) prophylaxis regimen significantly impacted grade II\u2013IV aGvHD 66.7% versus 19.2% (<jats:italic>p = .039<\/jats:italic>) and chronic graft\u2010versus\u2010host\u2010disease (cGvHD) 66.7% versus 0% (<jats:italic>p = .002<\/jats:italic>) in the patients receiving MSD or MUD PBSC compared to haplo\u2010BMT, respectively, resulting in improved GRFS in haplo\u2010BMT, 83.3% compared to 40% matched donor peripheral blood stem cell transplant (PBSCT) (<jats:italic>p = .025<\/jats:italic>).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Our results demonstrate that BU\u2010FLU\u2010MEL is efficacious conditioning for disease control in young patients with myeloid malignancies undergoing MSD or alternative donor allo\u2010HCT, but in the setting of PBSC grafts with cyclosporine A\u2010methotrexate (CSA\u2010MTX) GvHD prophylaxis, it results in an unacceptably high incidence of GvHD.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pbc.30102","type":"journal-article","created":{"date-parts":[[2022,11,17]],"date-time":"2022-11-17T10:19:34Z","timestamp":1668680374000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Busulfan, fludarabine, and melphalan are effective conditioning for pediatric and young adult patients with myeloid malignancies underdoing matched sibling or alternative donor transplantation"],"prefix":"10.1002","volume":"70","author":[{"given":"Laurel","family":"Truscott","sequence":"first","affiliation":[{"name":"Department of Pediatrics University of Arizona  Tucson Arizona USA"},{"name":"The University of Arizona Cancer Center  Tucson Arizona USA"},{"name":"Banner University Medical Center  Tucson Arizona 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