Efficacy and safety of Busulfan-Fludarabine versus Busulfan-Cyclophosphamide as a conditioning regimen prior to hematopoietic stem cell transplant in hematologic malignancy patients: a meta-analysis of randomized controlled trials and observational studies.

EFS at 2 years showed borderline significance (RR 1.18, 95% CI: 1.00–1.38; p = 0.05) and 5 years follow-up (RR 1.11, 95% CI: 1.01–1.24; p = 0.04) were significantly higher in Busulfan–Fludarabine, though 1-year EFS was not significantly different between the two groups (RR 1.10, 95% CI: 0.97–1.25; p = 0.15) (Table S3).

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While other studies, including Paina et al., 45 reported a numerically higher incidence of both acute and chronic GVHD with Busulfan–Cyclophosphamide compared to Busulfan–Fludarabine, these differences did not reach statistical significance, suggesting variability in patient populations and prophylaxis strategies may influence outcomes.

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