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Non-myeloablative allogeneic stem cell transplant with fludarabine and reduced dose cyclophosphamide in acute myeloid leukemia for older adults with comorbidities

Bone Marrow Transplantation volume 57, pages 1743–1745 (2022)Cite this article

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Reduced-intensity conditioning (RIC) and non-myeloablative (NMA) conditioning allow older patients (age > 55) with comorbidity to be candidates for allogeneic stem cell transplantation (allo-SCT). Fludarabine (Flu) and cyclophosphamide (Cy)-based NMA conditioning was reported with minimal cytopenia by Dr. Childs [1] and Khouri [2].

The Khouri regimen used a reduced Cy dose (0.9–2 g/m2) [2], which is a half or less compared to the Child regimen with standard Cy (120 mg/kg) [1] because, for example, a patient of 60 kg and 160 cm (surface: ∼1.7 m2) would receive total Cy of 1.5–3.4 g in the Khouri regimen (reduced Cy) instead of 7.2 g in the Child regimen (standard Cy). The Childs’ regimen in acute myeloid leukemia (AML) patients up to 66 years old reported improved outcomes [3, 4]. Using reduced Cy (total: 2 g/m2]) from Khouri’s FluCy regimen, we extended allo-SCT to the AML patients who are even older or with severe comorbidities.

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Data availability

The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

This work was supported by the Arlene Witmer Memorial Fund for Bone Marrow Cancer Research, the John and Denise Gilliland Fund for the Cancer Genetics Program, G. R. Sponaugle Employee Cancer Research Fund, Earl “Bumps” Clouser Memorial Lymphoma Research Endowment, and Richard E. and Stephanie A. Ziegler Charitable Foundation Endowment in Hematology. The authors would like to thank the patients who participated in this study and the technicians who participated in the experimental procedures.

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Authors and Affiliations

  1. Penn State Cancer Institute, 500 University Dr, Hershey, PA, 17033, USA

    Christopher J. Pizzola, Joseph Cioccio, Kevin L. Rakszawski, Myles Nickolich, W. Christopher Ehmann, Witold B. Rybka, Baldeep Wirk, Seema Naik, Hong Zheng, Brooke Silar, Hiroko Shike, Shouhao Zhou, Shin Mineishi, Kentaro Minagawa & David F. Claxton

  2. Division of Biostatistics and Bioinformatics, Penn State College of Medicine, 700 HMC Crescent Road, Hershey, PA, 17033, USA

    Shouhao Zhou

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  1. Christopher J. Pizzola
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Contributions

CP and KM drafted the paper under the supervision of HS, SM, and DC. CP, BS, and KM collected and analyzed patient data. SZ provided statistical input. JC, KR, MN, CE, WR, BW, SN, and HZ reviewed the paper and provided input.

Corresponding author

Correspondence to Kentaro Minagawa.

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The authors declare no competing interests.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Pizzola, C.J., Cioccio, J., Rakszawski, K.L. et al. Non-myeloablative allogeneic stem cell transplant with fludarabine and reduced dose cyclophosphamide in acute myeloid leukemia for older adults with comorbidities. Bone Marrow Transplant 57, 1743–1745 (2022). https://doi.org/10.1038/s41409-022-01821-4

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