Reduced Intensity Conditioning Leads to Less Transplant-Related Mortality for Older Patients With MDS

Ronald L. Paquette, MD, discusses how transplant related morbidity and mortality risks differ between age groups for patients with myelodysplastic syndrome.

Ronald L. Paquette, MD, clinical director, Stem Cell and Bone Marrow Transplant Program at Cedars-Sinai Medical Center and Samuel Oschin Cancer Center, discusses the transplant related morbidity and mortality risks and how they differ between the age groups for patients with myelodysplastic syndrome (MDS).

According to Paquette, patients with MDS are generally older. His research has shown transplant related mortality for older individuals to be consistent with previous data when using a reduced intensity conditioning regimen.

Fludarabine with total body radiation at a dose of 800 cGy is the current preferred regimen used to treat these patients, but the safety and efficacy are continuously being examined to make sure this method is best.

Transcription:

0:08 | Myelodysplastic syndrome patients in general are older. I'm gearing my discussion primarily to the older age group MDS, and of course MDS can happen in younger patients to where there are less concerns about conditioning related morbidity and mortality. What we found is that our transplant related mortality for older individuals is still less than 10% using a reduced intensity conditioning regimen. I think that's reassuring.

0:44 | What we found however, is that because we're using post-transplant cyclophosphamide as graft versus host disease prophylaxis, the use of alkylating agents as part of the conditioning regimen has led to undue toxicities not just in older age group, but even in younger patients. In our hands, Northland and the conditioning regimen is associated with thrombotic microangiopathy in some patients at a rate that's higher than the use of total body irradiation. We also see pulmonary toxicity with the use of alkylating agents in the conditioning regimen.

1:25 | Our go to regimen in older individuals is fludarabine with total body radiation at a dose of 800 cGy. That's been our preference recently. We are obviously monitoring the safety and efficacy of this regimen going forward. But we've been able to mitigate the risks of those two particular complications that we previously saw with melphalan containing regimens.