Work

Bendamustine, Fludarabine, and Rituximab (BFR) Conditioning with Post-Transplantation Cyclophosphamide and Tacrolimus Gvhd Prophylaxis for Lymphoma and Myeloma Haploidentical Stem Cell Transplantation

Year: 2025

Type: article

Abstract: Introduction This is a single-center, phase I prospective cohort study to assess the safety of a novel combination of Bendamustine , Fludarabine , and Rituximab (BFR) conditioning with post-transplantation cyclophosphamide . 20 patients with relapsed/refractory multiple myeloma or lymphoma participated in this study and underwent allogeneic hematopoietic stem cell transplantation (alloHSCT) between July 2018 and Oct 2021. The total study duration was 12 months, and patients are being followed up today (9/24/2024). Objectives Assess safety of BFR conditioning followed by PTCy GVHD prophylaxis for patients with myeloma and lymphoma undergoing haploidentical peripheral blood stem cell transplantation . Methods The patients with lymphoma received Rituximab on D-13, D-6, D+1 and D+8. All participants had Fludarabine and Bendamustine from D-5 to D-3. 200cGy of total body irradiation (TBI) was given on D-1. Patients received post-transplant cyclophosphamide GVHD prophylaxis on D+3 and D+4, without mycophenolate , and started tacrolimus on D+5. CD56-selected donor lymphocyte infusion was given on D+8 (Figure 1). Results The median age of 20 patients was 54.5 and that of their donors was 28.5. 13 out of 20 patients had multiple myeloma and 7 had lymphoma. 12 patients had 6/12 HLA matching , 6 patients had 7/12 HLA matching , and 2 patients had 8/12 HLA matching with their donor. 4 donors had KIR haplotype A/A, and 16 donors had KIR haplotype B/X. All patients achieved engraftment of neutrophils at 30 days post-transplantation and engraftment of platelets at 100 days post-transplantation. 6 out of 13 multiple myeloma patients were deceased and 7 patients are currently being followed. Overall, 10 patients developed progressive disease, and 8 had a relapse. 8 patients experienced acute GVHD , and 2 patients developed chronic GVHD . 1 out of 7 lymphoma patients were deceased and 6 patients are currently being followed up. Only one developed a progressive disease and had a relapse. All of them experienced acute GVHD , and two developed chronic GVHD . As of 9/24/2024, overall survival is 65%, 7 out of 20 patients died and 13 are still being followed. 6 deaths were related to malignancy , and one was a complication from infection of adenovirus (Figure 2). Progression Free Survival is 40%, a total of 12 of 20 patients either died or developed progressive disease, and 8 are still being followed. Conclusion Non-myeloablative BFR conditioning can be readily combined with PTCy GVHD prophylaxis without causing untoward alkylator-alkylator toxicity, and may represent an attractive option for patients who are unsuitable for reduced-intensity regimens or who have received prior radiation therapy.

Source: Transplantation and Cellular Therapy

DOI: 10.1016/j.jtct.2025.01.293