Jensen LG, et al. - As per previous reports, the addition of total-marrow-lymphoid irradiation (TMLI) to reduced intensity conditioning regimens (RIC) [Fludarabine (FLU) and Melphalan (MEL)] was feasible and safe in HCT for patients with advanced hematological malignancies. Here the researchers reported the long-term clinical outcomes of these patients. In the study population, TMLI addition to fludarabine/melphalan conditioning was well tolerated with favorable outcomes. There may be necessity for dose escalation of TMLI or other modification to improve disease control.

Methods

• 61 patients treated with TMLI to a dose of 12 Gy (1.5 Gy BID x 4 days), FLU (25 mg/m2/d x 5 days), and MEL (140 mg/m2/d x 1 day) were included in this prospective study.
• Measurement of overall survival (OS), event free survival (EFS), cumulative incidence of relapse (CIR) and non-relapse mortality (NRM) was performed from date of HCT.
• Using Kaplan-Meier analysis, survival outcomes were analyzed.
• Using Disease Risk Index, they categorized patients as low/intermediate or high/very-high risk.

Results

• Researchers followed the patients for median period of 7.4 years.
• Acute leukemia was identified in majority of patients (72%).
• Forty-nine percent of patients had high/very high-risk disease.
• Median age was 55 (range: 9-70).
• In this study, two-year OS, EFS, CIR and NRM were 54% (95% CI: 41-66%), 49% (95% CI: 36-61%), 21% (95% CI: 13-35%) and 30% (95% CI: 20-43%), respectively.
• 42% (95% CI: 30-54%), 41 % (95% CI: 28-53%), 26 (95% CI: 17-40%), and 33% (95% CI: 23-47%) were the five-year OS, EFS, CIR and NRM, respectively.
• Findings revealed acute (any grade) and chronic (limited or extensive) GVHD in 69% and 74% of patients, respectively.
• Mucositis was identified as the most common toxicity.