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Reduced intensity thiotepa-cyclophosphamide conditioning for allogeneic haemopoietic stem cell transplants (HSCT) in patients up to 60 years of age.
- Source :
-
British journal of haematology [Br J Haematol] 2000 Jun; Vol. 109 (4), pp. 716-21. - Publication Year :
- 2000
-
Abstract
- Unlabelled: Transplant-related mortality (TRM) remains a major problem in older patients undergoing allogeneic haemopoietic stem cell transplants (HSCTs). We have therefore explored a less intensive conditioning in 33 patients with a median age of 52 years (range 43-60) transplanted from human leucocyte antigen (HLA)-identical siblings. The underlying disease was chronic myeloid leukaemia (n = 15), acute myeloid leukaemia (n = 6), myelodysplasia (n = 7) or a chronic lymphoproliferative disorder (n = 5); 15 patients (45%) had advanced disease. The regimen consisted of thiotepa (THIO; 10 mg/kg) on day -5 and cyclophosphamide (CY; 50 mg/kg) on days -3 and -2 (total dose 100 mg/kg). The source was bone marrow (BM) (n = 17) or granulocyte colony-stimulating factor (G-CSF)-mobilized peripheral blood (PB) (n = 16), which were infused without manipulation. Graft-versus-host disease (GVHD) prophylaxis consisted of cyclosporin A (CyA) and a short course of methotrexate. Mean time to achieve a neutrophil count of 0.5 x 109/l was 17 d (range 11-23) and full donor chimaerism was detected in 79% of patients by day 100. Acute GVHD grade III or IV occurred in 3% of patients. Chronic GVHD was seen in 45% of patients, with a significant difference for PB (69%) compared with BM transplants (23%) (P = 0.009). For BM grafts, the actuarial 2-year TRM was 6%, the relapse 56% and survival 87%; for PB grafts, these figures were, respectively, 27%, 33% and 68%. Twenty-five patients are alive at a median follow-up of 762 d (range 216-1615) and 20 patients (60%) remain free of disease. Thirteen patients (39%) received donor lymphocyte infusion (DLI) either for persisting or relapsing disease and six patients had complete remission.<br />In Conclusion: (i) patients up to the age of 60 years can be allografted with reduced intensity conditioning; (ii) the procedure was associated with a low transplant-related mortality, particularly for bone marrow grafts, because of a lower risk of chronic GVHD; and (iii) DLI were required after transplant in half the patients for persisting disease or relapse.
- Subjects :
- Adult
Cyclophosphamide administration & dosage
Drug Administration Schedule
Female
Follow-Up Studies
Graft vs Host Disease mortality
Hematopoietic Stem Cell Transplantation mortality
Humans
Immunosuppressive Agents administration & dosage
Leukemia, Myelogenous, Chronic, BCR-ABL Positive mortality
Leukemia, Myelogenous, Chronic, BCR-ABL Positive surgery
Leukemia, Myeloid mortality
Leukemia, Myeloid surgery
Lymphoproliferative Disorders mortality
Lymphoproliferative Disorders surgery
Male
Middle Aged
Myelodysplastic Syndromes mortality
Survival Rate
Transplantation, Homologous
Antineoplastic Agents, Alkylating administration & dosage
Hematopoietic Stem Cell Transplantation methods
Myelodysplastic Syndromes surgery
Thiotepa administration & dosage
Transplantation Conditioning methods
Subjects
Details
- Language :
- English
- ISSN :
- 0007-1048
- Volume :
- 109
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- British journal of haematology
- Publication Type :
- Academic Journal
- Accession number :
- 10929020
- Full Text :
- https://doi.org/10.1046/j.1365-2141.2000.02123.x