The following is a summary of “Fludarabine melphalan versus fludarabine treosulfan for reduced intensity conditioning regimen in allogeneic hematopoietic stem cell transplantation: a retrospective analysis,” published in the November 2023 issue of Hematology by Chichra et al.

Various reduced-intensity conditioning (RIC) regimens minimize toxicity while yielding comparable outcomes to myeloablative conditioning regimens.

Researchers performed a retrospective study to analyze the toxicity and outcomes of two RIC regimens, fludarabine with melphalan (Flu-Mel) and fludarabine with treosulfan (Flu-Treo), in two donor groups, matched related donor (MRD)/matched unrelated donor (MUD) and haploidentical (Haplo) transplants, over 10 years.

They studied 138 patients, 105 of whom were undergoing MRD/MUD transplants (Flu-Mel: 94, Flu-Treo: 11) and 33 of whom were undergoing Haplo transplants (Flu-Mel: 17, Flu-Treo: 16).

The results showed that in the MRD/MUD group, 47% of patients receiving Flu-Mel experienced grade 3/4 oral mucositis, compared to 9% with Flu-Treo (P=0.02). In the Haplogroup, the corresponding numbers were 41% and 6%. Grade 3/4 diarrhea was more prevalent with Flu-Mel than Flu-Treo in the Haplogroup (41% vs. 6%; P=0.039) but not in the MRD/MUD group. The median follow-up time for all patients was 4.8 years. Five-year OS in the MRD/MUD group was 62% with Flu-Mel versus 53% with Flu-Treo (P=0.0694). Similarly, 5-year OS was 41% with Flu-Mel and 28% with Flu-Treo (P=0.770) in the Haplogroup. Flu-Treo demonstrated significantly lower rates of severe mucositis and diarrhea compared to Flu-Mel.

Investigators concluded that Flu-Treo demonstrated equivalent efficacy and safety to Flu-Mel in all donor transplants.

Source: link.springer.com/article/10.1007/s12185-023-03674-z