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Rapid induction of complete donor chimerism by the use of a reduced-intensity conditioning regimen composed of fludarabine and melphalan in allogeneic stem cell transplantation for metastatic solid tumors.

Authors :
Ueno NT
Cheng YC
Rondón G
Tannir NM
Gajewski JL
Couriel DR
Hosing C
de Lima MJ
Anderlini P
Khouri IF
Booser DJ
Hortobagyi GN
Pagliaro LC
Jonasch E
Giralt SA
Champlin RE
Source :
Blood [Blood] 2003 Nov 15; Vol. 102 (10), pp. 3829-36. Date of Electronic Publication: 2003 Jul 24.
Publication Year :
2003

Abstract

We evaluated the feasibility and efficacy of a reduced-intensity conditioning (RIC) regimen of fludarabine and melphalan to achieve rapid complete donor chimerism after allogeneic stem cell transplantation (SCT) in patients with metastatic solid tumors. Between January 1999 and January 2003, 8 patients with metastatic breast cancer (BC) and 15 with metastatic renal cell carcinoma (RCC) underwent allogeneic SCT after an RIC regimen of 5 days of fludarabine and 2 days of melphalan. Filgrastim-mobilized stem cells from HLA-identical related or unrelated donors were infused. Prophylaxis for graft-versus-host disease (GVHD) consisted of tacrolimus and methotrexate. All 22 evaluable patients had 100% donor chimerism at day 30 and at all measurement times thereafter. One patient died 19 days after SCT. Nine patients (39%) had grades II to IV acute GVHD and 10 patients (43%) had chronic GVHD. Five patients (22%) died of nonrelapse treatment-related complications. Treatment-related disease response was seen in 10 patients (45%), with 3 complete responses, 2 partial responses, and 5 minor responses. Fludarabine-melphalan is a feasible and effective RIC regimen for allogeneic SCT in metastatic BC and RCC. It induces rapid complete donor chimerism without the need for donor lymphocyte infusion. Tumor regression associated with GVHD is consistent with graft-versus-tumor effect.

Details

Language :
English
ISSN :
0006-4971
Volume :
102
Issue :
10
Database :
MEDLINE
Journal :
Blood
Publication Type :
Academic Journal
Accession number :
12881308
Full Text :
https://doi.org/10.1182/blood-2003-04-1022