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EBMT 2021 | TBF as allo-HSCT conditioning regimen for myelofibrosis patients

Florent Malard, MD, PhD, Saint Antoine Hospital, Paris, France, discusses the use of thiotepa-busulfan-fludarabine (TBF) as a conditioning regimen for patients with myelofibrosis who are undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT). Data from 27 patients with myelofibrosis who received allo-HSCT was analyzed. The cumulative incidence of graft-versus-host disease (GVHD) was 39% and the overall survival was 69%, at 3 years of follow-up. This study validates the use of TBF as a conditioning strategy in patients with myelofibrosis. This interview took place during the 47th Annual Meeting of the European Group for Blood and Marrow Transplantation (EBMT) 2021.

Transcript (edited for clarity)

This is a paper that was published recently when we use a conditioning regimen using thiotepa, busulfan and fludarabine in 29 patients with myelofibrosis. We know that’s an issue and we are going to perform allogeneic stem cell transplantation in patients with myelofibrosis. This is engraftment with some graft failure of some patients that have some delay, the platelet reconstitutions, that can really impair the patient’s outcome...

This is a paper that was published recently when we use a conditioning regimen using thiotepa, busulfan and fludarabine in 29 patients with myelofibrosis. We know that’s an issue and we are going to perform allogeneic stem cell transplantation in patients with myelofibrosis. This is engraftment with some graft failure of some patients that have some delay, the platelet reconstitutions, that can really impair the patient’s outcome.

So in our platform for conditioning regiment, we use thiotepa to improve patient’s engraftment, and in fact, it was pretty successful. This is very important also to highlight that we used peripheral blood stem cells in 27 out of 29 patients. So peripheral blood stem cells sometimes also are associated with an improved engraftment, so it was also very important parameters in those patients. In term of donors, we have match-related, unrelated, and also haploidentical donors, seven of them. All but two patients engrafted, so it was a very high rate of engraftment success.

In term of toxicity, we have 21% of acute grade two to four, or graft-versus-host disease. And at the end, we have an overall survival of 69% at three years, so this is a very long follow-up on the very high overall survival with this very high-risk population of patients. So, we really think that this TBF, so a thiotepa-busulfan-fludarabine-based platform, can be very successful for patients with myelofibrosis.

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