A Retrospective Study on Different Conditioning Approaches for Allogeneic Hematopoietic Cell Transplantation in Patients with Myelodysplastic Syndromes with an Excess of Blasts: Sequential, Myeloablative, and Reduced Intensity Conditioning
Introduction:
Myelodysplastic syndromes (MDS) are a group of hematological disorders characterized by ineffective blood cell production in the bone marrow. In some cases, MDS can progress to acute myeloid leukemia (AML), particularly when there is an excess of blasts in the bone marrow. Allogeneic hematopoietic cell transplantation (HCT) is a potentially curative treatment option for these patients. However, the conditioning regimen used prior to transplantation plays a crucial role in the success of the procedure. This retrospective study aims to compare the outcomes of three different conditioning approaches: sequential, myeloablative, and reduced intensity conditioning.
Sequential Conditioning:
Sequential conditioning involves the administration of chemotherapy followed by radiation therapy. The rationale behind this approach is to achieve a more effective reduction in tumor burden and immunosuppression. In this study, patients who received sequential conditioning showed a higher rate of complete remission before transplantation compared to the other two groups. However, the incidence of treatment-related mortality was also higher in this group, possibly due to the increased toxicity associated with sequential conditioning.
Myeloablative Conditioning:
Myeloablative conditioning involves the use of high-dose chemotherapy and/or total body irradiation to completely eradicate the patient’s bone marrow before transplantation. This approach aims to eliminate any residual disease and create space for the engraftment of donor cells. The study found that patients who underwent myeloablative conditioning had a lower incidence of relapse compared to the other two groups. However, this was offset by a higher risk of treatment-related mortality, particularly in older patients or those with comorbidities.
Reduced Intensity Conditioning:
Reduced intensity conditioning (RIC) is a less toxic alternative to myeloablative conditioning, particularly suitable for older patients or those with significant comorbidities. RIC involves the use of lower doses of chemotherapy and/or radiation therapy, allowing for engraftment of donor cells without complete eradication of the patient’s bone marrow. The study showed that patients who received RIC had a lower risk of treatment-related mortality compared to myeloablative conditioning. However, the incidence of relapse was higher in this group, suggesting that RIC may not be as effective in eradicating residual disease.
Conclusion:
This retrospective study provides valuable insights into the outcomes of different conditioning approaches for allogeneic HCT in patients with MDS with an excess of blasts. Sequential conditioning appears to achieve a higher rate of complete remission before transplantation but is associated with increased treatment-related mortality. Myeloablative conditioning reduces the risk of relapse but carries a higher risk of treatment-related mortality, particularly in older or comorbid patients. Reduced intensity conditioning offers a less toxic alternative for patients who are not suitable for myeloablative conditioning but may be associated with a higher risk of relapse. The choice of conditioning approach should be individualized based on patient characteristics and the balance between disease control and treatment-related toxicity. Further prospective studies are needed to validate these findings and optimize the conditioning regimens for this patient population.
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- Source Link: https://platohealth.ai/sequential-vs-myeloablative-vs-reduced-intensity-conditioning-for-patients-with-myelodysplastic-syndromes-with-an-excess-of-blasts-at-time-of-allogeneic-haematopoietic-cell-transplantation-a-retrospe/