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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.
- 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.
- Subjects :
- Adult
Antineoplastic Combined Chemotherapy Protocols therapeutic use
Antineoplastic Combined Chemotherapy Protocols toxicity
Breast Neoplasms mortality
Breast Neoplasms pathology
Carcinoma, Renal Cell mortality
Carcinoma, Renal Cell pathology
Female
Graft vs Host Disease drug therapy
Graft vs Host Disease prevention & control
Graft vs Tumor Effect
Humans
Male
Melphalan administration & dosage
Middle Aged
Neoplasm Metastasis therapy
Peripheral Blood Stem Cell Transplantation mortality
Remission Induction
Transplantation, Homologous
Treatment Outcome
Vidarabine administration & dosage
Antineoplastic Combined Chemotherapy Protocols administration & dosage
Breast Neoplasms therapy
Carcinoma, Renal Cell therapy
Peripheral Blood Stem Cell Transplantation methods
Transplantation Chimera
Transplantation Conditioning methods
Vidarabine analogs & derivatives
Subjects
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