Dr Koehne on the Use of Chemotherapy-Only Conditioning Regimens in Hematologic Malignancies

Guenther Koehne, MD, PhD, deputy director, chief, Blood and Marrow Transplant, Hematologic Oncology, Benign Hematology, Miami Cancer Institute, Baptist Health, discusses the advantages of using chemotherapy-only conditioning regimens for patients with hematologic malignancies undergoing allogeneic stem cell transplantation.

The administration of conditioning regimens prior to allogeneic donor-derived stem cell transplantation significantly impacts post-transplant outcomes in patients with hematologic malignancies, Koehne begins. Traditionally, the standard conditioning regimen involved high doses of total body irradiation combined with chemotherapy, aimed at eliminating the patient's immune system and bone marrow function to facilitate successful engraftment and immune reconstitution from the donor stem cells, Koehne explains. However, this approach is associated with a substantial adverse effect (AE) profile, including mucositis, infertility, and other complications associated with high-dose radiation, he says.

Koehne states that there has been a shift in understanding whether total body irradiation is necessary for all patients requiring stem cell transplantation across various malignancies. Research in certain tumor types, such as acute myeloid leukemia and myeloproliferative syndromes, has shown that chemotherapy-only conditioning regimens can be highly effective and sufficient for achieving successful transplantation outcomes, he expands. Importantly, these chemotherapy-only regimens are associated with fewer AEs and better patient tolerance compared with regimens that include total body irradiation, Koehne notes.

The use of chemotherapy-only conditioning regimens has also expanded the eligibility criteria for allogeneic stem cell transplantation, Koehne continues. By shifting away from total body irradiation and utilizing chemotherapy-only conditioning regimens, transplant physicians are able to optimize patient outcomes while minimizing treatment-related toxicity, Koehne states. This advancement has not only improved the safety and tolerability of stem cell transplantation but has also expanded access to this potentially curative treatment option for a broader range of patients, including those previously considered too frail or elderly for conventional conditioning approaches, he concludes.