Shimoni A, Robin M, Iacobelli S, et al. Allogeneic Hematopoietic Cell Transplantation in Patients with Myelodysplastic Syndrome Using Treosulfan Based Compared to Other Reduced-Intensity or Myeloablative Conditioning Regimens. A Report of the Chronic Malignancies Working Party of the EBMT. British Journal of Haematology. 2021; (doi: 10.1111/bjh.17817).
A fludarabine/treosulfan (FT) conditioning regimen may be preferred for patients with myelodysplastic syndrome (MDS) receiving allogeneic hematopoietic-cell transplantation (allo-HCT), according to new research. The regimen improved overall survival (OS), which the researchers attributed to FT having similarly low relapse rates to myeloablative-conditioning (MAC) and non-relapse mortality (NRM) rates as reduced-intensity conditioning (RIC). FL combines low toxicity and potent anti-leukemia activity. The researchers compared post-transplant outcomes between 367 MDS patients receiving FT, 687 receiving RIC, and 668 receiving MAC. The FT, RIC, and MAC recipients were respectively 59, 59, and 51 years old, on average, while their other disease traits were similar. Average follow-up was 64 months. The five-year relapse rate for FT recipients was 25%, compared with 38% after RIC and 25% after MAC. NRM was 30% following FT, 27% after RIC, and 34% after MAC. Those cohorts saw respective five-year OS of 50%, 43%, and 43%. Multivariate analysis demonstrated that a lower relapse risk and improved OS correlated with FT, while MAC was linked to a higher NRM.