AML/MDS: lower-dose conditioning effective in older patients receiving CBT

  • Ohta T & al.
  • Int J Hematol
  • 13 Jun 2019

  • curated by David Reilly
  • Univadis Clinical Summaries
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Takeaway

  • In elderly patients with acute myeloid leukemia (AML) or myelodysplastic syndromes (MDS) undergoing cord blood transplantation (CBT), a conditioning regimen using 75% of the standard dose of busulfan/cyclophosphamide (BU/CY) enabled early recovery, high rate of neutrophil engraftment, and acceptable nonrelapse mortality (NRM).

Why this matters

  • Conditioning regimens containing standard-dose BU/CY in the elderly have been associated with risk for NRM because of infectious disease.

Study design

  • Study to evaluate the safety and efficacy of a conditioning regimen using fludarabine (FLU)+75% of the standard dose of BU/CY in 21 older patients with AML (n=9) and MDS (n=12) who received unrelated CBT.
  • Median patient age, 65 (range, 58-73) years.
  • Funding: None disclosed.

Key results

  • 19 patients achieved neutrophil engraftment at a median of 19 (range, 14-29) days.
  • 90.5% (95% CI, 55.1%-98.3%) cumulative incidence of neutrophil engraftment at day 30.
  • 19% (95% CI, 5.7%-38.3%) NRM at day 100; 38.1% (95% CI, 17.6%-58.5%) NRM at 2 years.
  • 9.5% (95% CI, 1.5%-26.7%) cumulative relapse at 100 days; 19.0% (95% CI, 5.6%-38.5%) at 2 years.
  • Infectious disease was the most common cause of NRM, occurring in 2 patients.

Limitations

  • Retrospective data.