OBJECTIVE: The development of reduced-intensity conditioning regimens rather than myeloablative regimens for allogeneic stem cell transplantation has led to decreased treatment-related mortality and increased use of this treatment modality, especially in older patients with hematological malignancies. No randomized controlled trials have been performed resulting in determining effectiveness on phase II studies, which rarely report on long-term survival. MATERIALS AND METHODS: In an attempt to address this limitation, we analyzed a single-center cohort of 100 consecutive patients with hematological malignancies undergoing allogeneic stem cell transplantation from a human leukocyte antigen-matched related donor with median follow-up of 60 months. The reduced-intensity conditioning regimen consisted of oral Busulfan, rabbit anti-thymocyte globulin, and Fludarabin. RESULTS: Median age was 50 years (range, 18-64 years). The incidences of acute and chronic graft-vs.-host disease were 43% and 81%, respectively. The probability of nonrelapse mortality at 1 and 5 years was 15% and 25%, respectively. Nonrelapse mortality was adversely associated with acute graft-vs.-host disease (hazard ratio = 6; p = 0.0002). Of the 52 patients with measurable disease, 37 (71%) achieved a response. Relapse/progression occurred at a median of 11 months (range 1-52 months) in 21 patients, for a cumulative incidence of 22%. The probability of overall survival and progression-free survival at 5 years were 60% and 54%, respectively. Overall survival and progression-free survival were favorably influenced by having had previous autologous stem cell transplantation and a low CD34(+) cell dose. Overall survival, progression-free survival, and nonrelapse mortality improved over time in this cohort of patients. CONCLUSIONS: These results are encouraging for populations different in term of age, diagnosis, and disease status.
OBJECTIVE: The development of reduced-intensity conditioning regimens rather than myeloablative regimens for allogeneic stem cell transplantation has led to decreased treatment-related mortality and increased use of this treatment modality, especially in older patients with hematological malignancies. No randomized controlled trials have been performed resulting in determining effectiveness on phase II studies, which rarely report on long-term survival. MATERIALS AND METHODS: In an attempt to address this limitation, we analyzed a single-center cohort of 100 consecutive patients with hematological malignancies undergoing allogeneic stem cell transplantation from a human leukocyte antigen-matched related donor with median follow-up of 60 months. The reduced-intensity conditioning regimen consisted of oral Busulfan, rabbit anti-thymocyte globulin, and Fludarabin. RESULTS: Median age was 50 years (range, 18-64 years). The incidences of acute and chronic graft-vs.-host disease were 43% and 81%, respectively. The probability of nonrelapse mortality at 1 and 5 years was 15% and 25%, respectively. Nonrelapse mortality was adversely associated with acute graft-vs.-host disease (hazard ratio = 6; p = 0.0002). Of the 52 patients with measurable disease, 37 (71%) achieved a response. Relapse/progression occurred at a median of 11 months (range 1-52 months) in 21 patients, for a cumulative incidence of 22%. The probability of overall survival and progression-free survival at 5 years were 60% and 54%, respectively. Overall survival and progression-free survival were favorably influenced by having had previous autologous stem cell transplantation and a low CD34(+) cell dose. Overall survival, progression-free survival, and nonrelapse mortality improved over time in this cohort of patients. CONCLUSIONS: These results are encouraging for populations different in term of age, diagnosis, and disease status.
Authors: Nishitha M Reddy; Olalekan Oluwole; John P Greer; Brian G Engelhardt; Madan H Jagasia; Bipin N Savani Journal: Exp Hematol Date: 2013-10-02 Impact factor: 3.084
Authors: Rainer Storb; Boglarka Gyurkocza; Barry E Storer; Mohamed L Sorror; Karl Blume; Dietger Niederwieser; Thomas R Chauncey; Michael A Pulsipher; Finn B Petersen; Firoozeh Sahebi; Edward D Agura; Parameswaran Hari; Benedetto Bruno; Peter A McSweeney; Michael B Maris; Richard T Maziarz; Amelia A Langston; Wolfgang Bethge; Lars Vindeløv; Georg-Nikolaus Franke; Ginna G Laport; Andrew M Yeager; Kai Hübel; H Joachim Deeg; George E Georges; Mary E D Flowers; Paul J Martin; Marco Mielcarek; Ann E Woolfrey; David G Maloney; Brenda M Sandmaier Journal: J Clin Oncol Date: 2013-03-11 Impact factor: 44.544
Authors: Jan J Cornelissen; Alois Gratwohl; Richard F Schlenk; Jorge Sierra; Martin Bornhäuser; Gunnar Juliusson; Zdenek Råcil; Jacob M Rowe; Nigel Russell; Mohamad Mohty; Bob Löwenberg; Gerard Socié; Dietger Niederwieser; Gert J Ossenkoppele Journal: Nat Rev Clin Oncol Date: 2012-09-04 Impact factor: 66.675