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Outcomes of attenuated dose fludarabine and melphalan based conditioning regimen in patients undergoing allogeneic stem cell transplant: a propensity score-matched analysis

Year: 2025

Type: article

Abstract: Allogenic hematopoietic stem cell transplant (alloHCT) is a potentially curative treatment option among patients with hematologic malignancies. Giralt et al. evaluated the fludarabine (F) with melphalan (M) regimen as a reduced-intensity conditioning regimen [ 1 ]. In a multiple propensity-score (PS) adjusted analysis, Ciurea et al. evaluated fludarabine with melphalan 100 mg/m 2 (FM100) in patients with AML, and showed that FM100 was associated with an improved survival [ 2 ]. While the authors performed PS-adjustment for multiple variables, matching for HCT-CI score and renal dysfunction were not performed [ 2 ], which are common reasons to decrease melphalan dose. Creatinine and creatinine-based eGFR calculations, such as the Cockcroft-Gault equation, are commonly used for pre-transplant evaluation. However, creatinine is affected by factors such as muscle mass, malnutrition, etc., limiting its usefulness. Measured GFR (mGFR) using inulin, iothalamate, etc. provides the most accurate measure of kidney function [ 3 , 4 ]. The most common reasons to decrease melphalan dose include decreased renal function, comorbidities and advanced age, as seen in our cohort as well (Table S1 ). The goal of this study was to determine outcomes of fludarabine with attenuated dosed melphalan (<140 mg/m 2 ) (aFM) compared to FM140. We conducted a PS matched analysis, matched for high HCT-CI score, advanced age and low iothalamate clearance in comparing the outcomes of aFM versus FM140. Please refer to Supplementary Methods for further details.

Source: Bone Marrow Transplantation

DOI: 10.1038/s41409-025-02565-7