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Triplet Combo Effective Conditioning Regimen for Patients With AML, MDS, or MPNs
A study on treosulfan, fludarabine, and cytarabine found the combination provided tolerable, feasible, and effective conditioning for patients with acute myeloid leukemia (AML), myelodysplastic syndromes (MDS), or myeloproliferative neoplasms (MPNs; J Cancer Res Clin Oncol. 2021 Oct 21. Online ahead of print).
Although treosulfan and fludarabine have been successfully introduced into toxicity-reduced conditioning for stem cell transplant (SCT), the risk of post-SCT relapse remains concerning.
Thus, Jochen J Frietsch, MD, Department of Hematology and Internal Oncology, Jena University Hospital, and co-investigators, reported on the results of a novel treatment approach that utilized treosulfan, fludarabine, and cytarabine conditioning prior to allogenic SCT in patients with AML, MDS, or MPN.
The study enrolled 77 patients at high risk of disease relapse due to unfavorable cytogenetics or failure to achieve complete remission (CR) prior to SCT. The median follow-up was 3.2 years.
The 1-, 2- and 3-year recurrence free survival (RFS) rates were 49.4 percent, 41.7 percent, and 37.6 percent. The overall survival (OS) rates were 59.3 percent, 49.3 percent, and 45.4 percent, respectively.
The incidence of NRM was 10 percent at 100 days, 18.8 percent at year 1, and 20.1 percent at year 2. The level of relapse increased from 31 percent at year 1 to 38.5 percent after year 3. The frequency of engraftment, chimerism, graft-versus-host-disease (GVHD), and other toxicities were acceptable and comparable with similar patient conditioning, such as treosulfan and fludarabine, or fludarabine, amsacrine, and cytarabine.
Dr Fritsch concluded that the incidence of NRM and relapse is acceptable in this heavily pre-treated population with high-risk disease. “Future research will aim to confirm these initial findings and include a larger number of participants in a prospective trial,” he said.—Emily Bader
