A clinical study tested a less aggressive bone marrow transplant preparation protocol in patients aged 60 and older. By combining radiotherapy directed only at the marrow and reduced chemotherapy, which are less toxic options for the body, 45% of patients were alive and without worsening of the disease after two years.
The overall survival rate during the same period, that is, the number of patients alive, whether the disease had returned or not, was also 45%. In other words, this means that the protocol is ideal for frail elderly people, ensuring effectiveness with low toxicity in this population.
The study was carried out by researchers at Einstein Israelita Hospital. The results were presented at the American Society of Hematology (ASH) Annual Meeting, held in Orlando, Florida, USA, from December 6-9.
Bone marrow transplantation, as hematopoietic stem cell transplantation (HCT) is commonly called, replaces diseased cells in the bone marrow with healthy cells from a donor.
The procedure is performed on patients with leukemia (which affects blood cells in the bone marrow), multiple myeloma (which affects defense cells), and myelodysplastic syndromes (which affect the production of healthy cells).
Before undergoing a transplant of this type, patients must take a series of medications and undergo radiation therapy to prepare the body. In the standard protocol, the process is more aggressive and can be dangerous, especially for more fragile elderly people with other health problems.
“In this conditioning stage to prepare the body for transplantation, the patient is subjected to high-dose chemotherapy and radiotherapy. This is a very critical and heavy stage, because it generates high toxicity. Some patients can die,” explains Mariana Kerbauy, specialist in hematology and bone marrow transplantation and doctor at Einstein Israelita Hospital.
The Einstein study evaluated 28 elderly people, with an average age of 67, between 2017 and 2024. Half of them had active disease or were resistant to previous treatments, that is, they were more difficult cases. All were followed for approximately 34 months.
Researchers used a more tolerable combination to prepare patients: busulfan and fludarabine for lighter chemotherapy and more precise radiation therapy.
Patients underwent targeted spinal irradiation (TMI), which was more targeted than the traditional technique called total body irradiation (TBI). Both procedures destroy malignant cells.
In IMT, radiation is applied precisely and directly to the bone marrow, located throughout the skeleton, and is adjusted to primarily target the areas needed.
“When we do traditional radiotherapy, we irradiate the whole body of the patient. So it ends up being toxic to the lungs, to the intestine. But in the case of targeted irradiation, we design exactly where the radiation is going to reach,” explains Kerbauy.
The benefit is that IMT helps protect other organs and tissues that do not need to be irradiated, increasing effectiveness and reducing side effects, such as skin redness, hair loss, diarrhea, and taste changes.
The patient remains lying down while a machine delivers high-energy beams of radiation to targeted areas of the bone marrow. The procedure takes about 30 minutes to an hour and is generally painless.
“We have shown that it is possible to perform transplantation in elderly patients who, with the conventional protocol, would not tolerate the preparation and would have little chance of recovery. Thanks to this technique, we were able to successfully treat this previously excluded population,” explains Kerbauy.
Understanding the study results
Traditional problem:
- Elderly patients with severe leukemia or myelodysplastic syndromes need a bone marrow transplant to have a chance of recovery.
- But classical conditioning (chemotherapy and radiotherapy) is too toxic for them, causing organ failure and infections.
- Elderly people cannot therefore undergo a transplant. Without a transplant, they are unlikely to be cured, as the disease progresses and kills.
The solution with the new technique:
- With IMT (precise radiation only to the spinal cord), toxicity decreases significantly, because the radiation is directed only to the necessary areas, thereby protecting other organs and tissues.
- Thanks to the new protocol, elderly people can therefore tolerate the preparation: they undergo the transplant successfully and have a greater chance of recovery.
The journalist came at the invitation of Johnson & Johnson.
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