Conditioning regimens including high-dose busulfan cause a high incidence of transplant-related mortality after myeloablative stem cell transplantation.

Background: Transplant-related mortality (TRM) significantly decreases the long-term survival of patients with hematopoietic diseases who undergo hematopoietic stem cell transplantation (HSCT).

Methods: We retrospectively evaluated the risk factors for TRM of 58 consecutive patients with hematopoietic disease who underwent allogeneic myeloablative HSCT between April 1994 and June 2002.

Results: Thirty-one patients died after HSCT, 16 of whom were diagnosed as TRM. The actuarial incidence of TRM was 57.6 % in patients who received conditioning chemotherapies including high-dose busulfan and 19.4 % in those who did not (p = 0.008). Multivariate Cox model analysis revealed that disease status, graft versus host disease (GVHD) grades III-IV and the use of high-dose busulfan were significant and independent risk factors for TRM.

Conclusions: These results suggest that high-dose busulfan as a conditioning therapy for allogeneic HSCT should be used cautiously, especially in patients with advanced disease.