PURPOSE: Reduced-intensity conditioning (RIC) for allogeneic stem-cell transplantation (allo-SCT) reduces nonrelapse mortality (NRM). This reduction makes it possible for patients who are ineligible for high-dose myeloablative conditioning allo-SCT to benefit from graft-versus-leukemia reaction. In this multicenter, prospective study of patients with acute myeloid leukemia (AML) and high-risk myelodysplastic syndrome (MDS), we investigated the efficacy of RIC allo-SCT from a human leukocyte antigen-identical sibling by using a regimen that uses fludarabine and busulfan. PATIENTS AND METHODS: Ninety-three patients with AML (n = 59) and MDS (n = 34) were included, and the median age was of 53 years. Follow-up for survivors was 43 months (range, 3 to 89 months). The conditioning regimen consisted of fludarabine (150 mg/m(2)) and oral busulfan (8 to 10 mg/kg). All except one patient received mobilized peripheral blood stem cells. Graft-versus-host disease (GVHD) prophylaxis consisted of cyslosporine and methotrexate or mycophenolate mofetil. RESULTS: The 100-day, 1-year, and 4-year incidences of NRM were 8, 16%, and 21%, respectively. The 1- and 4-year relapse cumulative incidences were 23% and 37%, respectively, and leukemia recurrence was the main cause of death. The 4-year disease-free survival (DFS) and overall survival (OS) rates were 43% and 45%, respectively. The 4-year cumulative incidence of chronic GVHD was 53% (45% extensive), and its development was the major factor associated with lower relapse incidence and improved DFS and OS. CONCLUSION: Our results confirm the capacity of this RIC regimen to obtain long-term remissions in patients ineligible for a conventional allo-SCT. The results suggest an important role of the development of chronic GVHD in reducing relapse and improving DFS and OS.
PURPOSE: Reduced-intensity conditioning (RIC) for allogeneic stem-cell transplantation (allo-SCT) reduces nonrelapse mortality (NRM). This reduction makes it possible for patients who are ineligible for high-dose myeloablative conditioning allo-SCT to benefit from graft-versus-leukemia reaction. In this multicenter, prospective study of patients with acute myeloid leukemia (AML) and high-risk myelodysplastic syndrome (MDS), we investigated the efficacy of RIC allo-SCT from a human leukocyte antigen-identical sibling by using a regimen that uses fludarabine and busulfan. PATIENTS AND METHODS: Ninety-three patients with AML (n = 59) and MDS (n = 34) were included, and the median age was of 53 years. Follow-up for survivors was 43 months (range, 3 to 89 months). The conditioning regimen consisted of fludarabine (150 mg/m(2)) and oral busulfan (8 to 10 mg/kg). All except one patient received mobilized peripheral blood stem cells. Graft-versus-host disease (GVHD) prophylaxis consisted of cyslosporine and methotrexate or mycophenolate mofetil. RESULTS: The 100-day, 1-year, and 4-year incidences of NRM were 8, 16%, and 21%, respectively. The 1- and 4-year relapse cumulative incidences were 23% and 37%, respectively, and leukemia recurrence was the main cause of death. The 4-year disease-free survival (DFS) and overall survival (OS) rates were 43% and 45%, respectively. The 4-year cumulative incidence of chronic GVHD was 53% (45% extensive), and its development was the major factor associated with lower relapse incidence and improved DFS and OS. CONCLUSION: Our results confirm the capacity of this RIC regimen to obtain long-term remissions in patients ineligible for a conventional allo-SCT. The results suggest an important role of the development of chronic GVHD in reducing relapse and improving DFS and OS.
Authors: Charles Craddock; Sandeep Nagra; Andrew Peniket; Cassandra Brookes; Laura Buckley; Emmanouil Nikolousis; Nick Duncan; Sudhir Tauro; John Yin; Effie Liakopoulou; Panos Kottaridis; John Snowden; Donald Milligan; Gordon Cook; Eleni Tholouli; Tim Littlewood; Karl Peggs; Paresh Vyas; Fiona Clark; Mark Cook; Stephen Mackinnon; Nigel Russell Journal: Haematologica Date: 2009-11-30 Impact factor: 9.941
Authors: Pere Barba; Rodrigo Martino; Qin Zhou; Christina Cho; Hugo Castro-Malaspina; Sean Devlin; Albert Esquirol; Sergio Giralt; Ann A Jakubowski; Dolores Caballero; Molly Maloy; Esperanza B Papadopoulos; José Luís Piñana; María Laura Fox; Francisco J Márquez-Malaver; David Valcárcel; Carlos Solano; Lucía López-Corral; Jorge Sierra; Miguel-Angel Perales Journal: Biol Blood Marrow Transplant Date: 2018-01-02 Impact factor: 5.742
Authors: P Barba; R Martino; G Orti; A Esquirol; S Perez-Hoyos; J Sierra; D Valcárcel Journal: Bone Marrow Transplant Date: 2015-06-22 Impact factor: 5.483
Authors: J De La Serna; J Sanz; A Bermúdez; M Cabrero; D Serrano; C Vallejo; V Gómez; J M Moraleda; S G Perez; M D Caballero; E Conde; J J Lahuerta; G Sanz Journal: Bone Marrow Transplant Date: 2016-03-07 Impact factor: 5.483