Less Is More
Reduced-Intensity Regimen Before BMT Is Better for Older Leukemia Patients
A study led by researchers at the OSUCCC – James shows that preparing older acute myeloid leukemia (AML) patients for bone marrow transplants (BMT) with a reduced-intensity conditioning regimen is associated with higher rates of disease-free survival relative to the more typical treatments these patients usually receive.
The study was presented at the December 2012 American Society of Hematology (ASH) Annual Meeting in Atlanta, Ga.
Typically, the prognosis for older AML patients is poor. Even among patients who achieve complete remission through chemotherapy, survival rates are low due to high risk of relapse. While blood or bone marrow transplants can be a viable option for younger patients, conventional preparative regimens for the procedure are often too toxic for patients over age 60.
“With a reduced-intensity regimen leading up to a transplant, the disease-free survival rate in older patients reached 39 percent,” says Steven Devine, MD, professor in the Division of Hematology at Ohio State and director of the Blood and Marrow Transplant Program. “These outcomes are better than those achieved using more conventional treatments and warrant additional comparison research focused on preventing relapse in this patient population.”
The objective of the phase II, prospective, multicenter trial was to determine the feasibility and effectiveness of a uniform reduced-intensity conditioning regimen prior to a blood cell transplant in older AML patients in clinical remission. The primary endpoint was two-year disease-free survival. Researchers hypothesized that disease-free survival at two years would exceed 20 percent.
The study involved 123 AML patients in first clinical remission following chemotherapy, ages 60-74, who were transplanted at 21 centers across the country. Rates of both acute and chronic graft-vs.-host disease and treatment-related mortality were relatively low. No unexpected toxicities were associated with the transplants. Relapse was the most common cause of death.
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