Comparing pre-stem cell transplantation chemotherapy: myeloblative vs reduced-intensity conditioning therapy

The authors compared two different intensities of chemotherapy regimens for use before allogenic stem cell transplantation. The authors suggested that the two treatments had similar patient outcomes, with more intense therapy having slightly better outcomes. 

Hodgkin lymphoma (HL) is considered a curable disease. However, roughly 5-10% of patients will not be cured with first-line therapy, and up to 30% will relapse. A second-line option for treatment is allogenic stem cell transplantation (allo-SCT) from a matched donor. This requires extensive chemotherapy, known as myeloablative conditioning (MAC), before transplantation.

Patients have had poor outcomes when following MAC. Reduced-intensity conditioning (RIC) uses lower doses of chemotherapies. This can lead to a higher relapse rate. Recent treatment advances have led to MAC becoming easier to tolerate. The long-term outcomes of MAC and RIC before allo-SCT are still being investigated. 

This study examined the survival outcomes for patients treated with MAC or RIC.. The medical records of 312 patients were reviewed. 63 patients were treated with MAC and 249 were treated with RIC. Average follow-up was 56 months.

There was no significant differences in 5-year non-relapse mortality (time from treatment until death without relapse).  Patients in the MAC group had a lower rate of relapse (46% of patients) than those treated with RIC (55% of patients). The MAC group also had better rates of 2-year event-free survival (48%; no relapse, complication, or death) than patients in the RIC group (36%).

Patients treated with MAC therapy tended to have better outcomes than those receiving RIC therapy. These differences, however, were not statistically significant.

This study concluded that MAC was associated with improved event-free survival. Other outcomes were not significantly different between the groups.

Talk to your doctor about the different risks and benefits associated with myeloblative conditioning therapy and reduced-intensity conditioning therapy when considering allogenic stem cell transplantation.