By Bart Scott, MD

2008-12-07

Reduced-intensity conditioning (RIC) regimens remain a major theme this year at the ASH annual meeting. Several investigators will present retrospective studies evaluating the use of RIC regimens in a variety of malignancies including ALL, non-Hodgkin lymphoma, and AML/MDS. On Monday morning (7:00 a.m., Gateway Ballroom 104 – South), Dr. Boglarka Gyurkocza and colleagues will present a retrospective evaluation of nonmyeloablative HCT for de novo and secondary AML, and Dr. Yvette Kasamason and colleagues will present results with a nonmyeloablative conditioning regimen and haploidentical donor HCT.

Dr. Mohamad Mohty and colleagues use the European registry data to compare results with reduced and conventional conditioning in ALL (abstract #793). This abstract will be discussed during an oral session on clinical transplantation on Tuesday at 7:00 a.m. (20002-2004 – West). The benefit of RIC regimens is the low transplant-related mortality. However, the potential disadvantage may be a higher risk of relapse. To date, no prospective randomized trial evaluating conditioning intensity has been completed.

Several abstracts will focus on the growing use of cord blood as a stem cell source for HCT. For example, during the same oral session in Gateway Ballroom 104, Dr. Marcos De Lima and colleagues will present the results of a randomized trial evaluating the use of expanded cord blood stem cells (abstract #154). Additionally, Dr. Mary Eapen and colleagues will compare transplant outcomes on the basis of stem cell source, unrelated marrow, blood, or cord blood in adults (abstract #151). The authors found that transplant-related mortality was less in patients who received matched peripheral blood or bone marrow stem cells than in patients who received cord blood. The appropriate incorporation of cord blood HCT remains a key area of interest in the field of transplantation.

The most appropriate choice of consolidation therapy in patients with AML remains a key clinical question. For example, Dr. Jacob M. Rowe and colleagues, during an oral session today at 4:30 p.m. (2009-2011-2022-2024 – West), will discuss the treatment-related mortality and relapse rate following initiation of post-remission therapy (allogeneic HCT, autologous HCT, or intensive chemotherapy) for AML (abstract #49). Interestingly, the treatment-related mortality of peripheral blood autologous HCT was only 1.5 percent. Dr. Hisashi Sakamaki and colleagues will discuss the results of a randomized study evaluating allogeneic HCT versus intensive chemotherapy in patients with AML during the 11:00 a.m. oral session on Monday (abstract #347). Allogeneic HCT reduced the risk of relapse and improved survival in AML patients with intermediate- or poor-risk cytogenetic classification. Cytogenetic risk remains an important determinant of appropriate consolidation in patients with AML.

Many abstracts will present new agents and new combinations for the treatment of GVHD. During today’s Oral Session titled “Clinical Transplantation: Acute GVHD Prevention and Risk Assessment” at 4:30 p.m. (3001-3003-3005 – West), Dr. Amin Alousi and colleagues will present data from a phase II study evaluating the combination of etanercept, mycophenolate, denileukin difitox, or pentostatin with corticosteroids (abstract #55). The investigators will demonstrate that mycophenolate with corticosteroids have complete response rate at day 28 of 60 percent with relatively low infectious complications. During the same session, Dr. Jürgen Finke and colleagues will present data regarding the use of ATG pre-transplant for the prevention of GVHD (abstract #57). The investigators are able to show a benefit of adding ATG pre-transplant in a large phase III randomized trial for HCT using matched unrelated donors.

Many exciting abstracts will be presented in the transplant sessions this year. Major areas of investigation include the use of RIC, cord blood HCT, consolidation of AML, and new agents designed to treat and prevent GVHD. The curative potential of HCT is expanding thanks to use of alternative donors and modified conditioning regimens.

Dr. Scott indicated no relevant conflicts of interest.

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