Reduced‐intensity Allogeneic Transplantation Regimens

Sandmaier, Brenda M.; Storb, Rainer

doi:10.1002/9781118416426.ch21

Cited by 2 publications

(1 citation statement)

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“…Toxicity is a major limitation of conventional myeloablative conditioning (MAC) in allogeneic hematopoietic stem cell transplantation (HSCT). Alkylating agents combined with fludarabine, which is a purine analog that has an immunosuppressive effect and inhibits DNA repair after alkylating agent-induced DNA damage, 1,2 contribute to reducing the intensity and toxicity of conditioning regimens, enabling the growing population of older or medically infirm patients to access allogeneic HSCT. [3][4][5] Fludarabine combined with 140 mg/m 2 of melphalan (FM140) or 6.4 mg/kg of busulfan (FB2) is the most frequently used reduced-intensity conditioning.…”

Section: Introductionmentioning

confidence: 99%

Comparison of fludarabine‐based conditioning regimens in adult cord blood transplantation for myeloid malignancy: A retrospective, registry‐based study

Kurita,

Imahashi,

Chiba

et al. 2024

American J Hematol

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Fludarabine/busulfan and fludarabine/melphalan are viable options as conditioning regimens. However, the optimal fludarabine‐based conditioning in cord blood transplantation (CBT) remains unclear. Therefore, this retrospective, registry‐based study aimed to analyze the impact of five fludarabine‐containing conditioning regimens on 1395 adult patients (median age, 61 years) with acute myeloid leukemia, myelodysplastic syndrome, and chronic myeloid leukemia who underwent their first CBT. Treatment outcomes of fludarabine combined with melphalan (100–140 mg/m2) and low‐dose total body irradiation (TBI; FM140T); melphalan (80–99 mg/m2) and TBI (FM80T); busulfan (12.8 mg/kg) and melphalan (FB4M); busulfan (12.8 mg/kg) and TBI (FB4T); and busulfan (6.4 mg/kg) and TBI (FB2T) were compared. The 3‐year survival rate was 67%, 53%, 44%, 36%, and 39%, respectively (p < .0001). The FM140T survival rate was the most favorable after adjusting for confounders, and the hazard ratios (vs. FM140T) for overall mortality were as follows: FM80T, 1.6 (95% confidence interval [CI], 1.2–2.2); FB4M, 2.1 (95% CI, 1.6–2.8); FB4T, 2.7 (95% CI, 2.0–3.7); and FB2T, 2.2 (95% CI, 1.6–3.1). The better survival observed with FM140T, regardless of the disease, disease risk, age, or transplant year, was attributed to the lower relapse rate and lower non‐relapse mortality (NRM) associated with fewer infectious deaths. Conversely, FB4T was associated with a higher relapse rate and higher NRM. The findings indicate that the outcomes of CBT in myeloid malignancies were highly dependent on both the alkylating agent and its dose in combination with fludarabine. Therefore, compared with fludarabine/busulfan‐based conditioning, FM140T may be the preferred regimen.

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