Multiple Myeloma Coverage from Every Angle

Update on Reduced-Intensity Conditioning for Certain Hematologic Malignancies

By: Sarah Campen, PharmD
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.

By continuing to browse this site you permit us and our partners to place identification cookies on your browser and agree to our use of cookies to identify you for marketing. Read our Privacy Policy to learn more.