Evolving Strategies in Hematopoietic Stem Cell Transplant Conditioning

Sergio A. Giralt, MD, professor of medicine at Weill Cornell Medical College, attending physician in the Adult Bone Marrow and Transplant Service at Memorial Sloan Kettering Cancer Center (MSKCC), deputy division head of the Division of Hematologic Malignancies, and Melvin Berlin Family Chair in Multiple Myeloma at MSKCC, discusses what the most commonly used conditioning regimens for patients with myelodysplastic syndrome (MDS) undergoing transplants are.

According to Giralt, the majority of patients who are undergoing transplants today are older, which influences the type of conditioning they receive. Older patients with MDS often receive reduced intensity conditioning regimens. These regimens tend to be less aggressive than traditional myeloablative therapies.

The specific regimens mentioned include:

• Fludarabine plus Melphalan: A combination of 2 drugs used for conditioning.
• Fludarabine plus Busulfan: Another combination that is commonly used.

In this video, Giralt further highlights the evolving landscape of conditioning regimens in stem cell transplantation, emphasizing the shift towards tailored approaches for older patients. He also acknowledges the promising data and ongoing research efforts in this space.

Transcription:

0:09 | Currently, most of the patients undergoing transplants are older patients, so many of them are getting reduced intensity conditioning with either fludarabine/melphalan or fludarabine/busulfan. We do know, based on a randomized trial, that myeloablative therapies are associated with better outcomes. So fludarabine/busulfan at full dose or fludarabine/melphalan have been probably the most common ones utilized.

0:36 | There is important data with fludarabine/treosulfan that seem to be emerging. Treosulfan is now commercially available in the US. Many of us are exploring investigational strategies with myeloablative therapies, combining alkylators like thiotepa with fludarabine and busulfan, or fludarabine and melphalan in conjunction with what we call CD34 engineered grafts. Then, there are the Memorial Sloan Kettering CD34 selection trials that have recently been published.