Update on Reduced-Intensity Conditioning for Certain Hematologic Malignancies
Posted: Tuesday, September 4, 2018
A reduced-intensity conditioning regimen of fludarabine, cyclophosphamide, and total-body irradiation appears to be effective for patients with certain hematologic malignancies who are unable to withstand myeloablative conditioning. According to a study of 292 patients who received allogeneic hematopoietic cell transplantation, the regimen produced “highly successful outcomes” in patients with indolent lymphoma, chronic myeloid leukemia (CML), and those with a low-risk disease risk index, with a probability of 5-year overall survival of 78%, 53%, and 64%, respectively. The research findings were published in Biology of Blood and Marrow Transplantation.
The risk of relapse was lowest in those with indolent non-Hodgkin lymphoma (0%) and CML (13%). However, high rates of relapse were observed in patients with a high-risk disease risk index (57%), those with multiple myeloma (75%), and Hodgkin lymphoma (53%); moderate rates of relapsed were reported in those with acute myeloid leukemia (37%) and myelodysplastic syndrome (39%).
“More stringent disease burden criteria at transplant and initiation of targeted post-transplant maintenance therapy approaches are needed to improve outcomes for the higher risk hematologic malignancy patients treated with our [reduced-intensity conditioning] platform,” concluded Erica Warlick, MD, of the University of Minnesota, Minneapolis, and colleagues.
The researchers also noted that rates of acute graft-versus-host disease were higher than expected in comparison with other contemporary studies. Prophylaxis included cyclosporine and mycophenolate mofetil. The incidence of grades II to IV acute graft-versus-host disease was 43% and of grades III to IV was 27%, with the highest rates in patients receiving an unrelated donor peripheral blood stem cell donation (50%). “Our data suggest that alternative [graft-versus-host disease] prophylaxis strategies may be preferred,” stated Dr. Warlick and colleagues.
