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[Progresses in pretransplant conditioning strategies].

Naoyuki Uchida1

  • 1Department of Hematology, Toranomon Hospital.

[Rinsho Ketsueki] the Japanese Journal of Clinical Hematology
|January 16, 2018
PubMed
Summary

Hematopoietic stem cell transplantation conditioning regimens have evolved. Newer, less toxic regimens like fludarabine-intravenous busulfan (Flu-ivBu) show promise for myeloid malignancies, especially in older adults.

Keywords:
Intravenous busulfanMyeloablative conditioningNon-relapse mortalityReduced-intensity conditioning

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Area of Science:

  • Hematopoietic Stem Cell Transplantation
  • Malignancy Treatment
  • Pharmacology

Background:

  • Reduced intensity conditioning in the late 1990s increased relapse rates despite more transplantations.
  • Conditioning regimens were intensified in the 2000s with drugs exhibiting reduced non-hematological toxicity.

Purpose of the Study:

  • To evaluate the efficacy and safety of intensified pretransplant conditioning regimens.
  • To assess the role of intravenous busulfan (ivBu) and fludarabine-ivBu combinations in myeloid malignancies.

Main Methods:

  • Review of conditioning regimens, focusing on the introduction and use of intravenous busulfan (ivBu).
  • Comparison of fludarabine-ivBu combination with conventional myeloablative regimens (Bu-Cy, TBI-Cy) in patients aged 50 and older.
  • Analysis of early non-relapse mortality (NRM) in patients in remission.

Main Results:

  • Intravenous busulfan (ivBu) offers myeloablative dosing with acceptable safety, including in elderly patients.
  • The fludarabine-ivBu combination demonstrates comparable or superior outcomes to conventional myeloablative regimens for older adults.
  • Early NRM in remission patients on Flu-ivBu was similar to the Seattle regimen (Flu+TBI 2 Gy).

Conclusions:

  • Fludarabine-ivBu represents an effective and safe myeloablative conditioning option for myeloid malignancies, particularly in older patients.
  • Further research into novel drugs for conditioning regimens may reduce toxicity, especially for patients not in remission.