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Unmanipulated haploidentical bone marrow transplantation and posttransplantation cyclophosphamide for hematologic malignancies after myeloablative conditioning.
- Source :
-
Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation [Biol Blood Marrow Transplant] 2013 Jan; Vol. 19 (1), pp. 117-22. Date of Electronic Publication: 2012 Aug 29. - Publication Year :
- 2013
-
Abstract
- Fifty patients with high-risk hematologic malignancies, underwent an unmanipulated haploidentical bone marrow transplantation (BMT), followed by posttransplantation high-dose cyclophosphamide (PT-CY): the myeloablative (MA) conditioning consisted of thiotepa, busulfan, fludarabine (n = 35), or total body irradiation (TBI), fludarabine (n = 15). The median age was 42 years (range, 18-66 years); 23 patients were in remission, 27 had active disease, and 10 patients were receiving a second allograft. Graft-versus-host disease (GVHD) prophylaxis consisted in PT-CY on day +3 and +5, cyclosporine (from day 0), and mycophenolate (from day +1). Three patients died before engraftment, and 2 patients had autologous recovery: 45 patients (90%) had full-donor chimerism on day +30. The median day for neutrophil engraftment was day +18 (range, 13-30 days). The cumulative incidence of grade II-III acute GVHD (aGVHD) was 12%, and of moderate chronic GVHD (cGVHD) 10%. With a median follow-up for surviving patients of 333 days (range, 149-623 days), the cumulative incidence of transplantation-related mortality (TRM) was 18%, and the rate of relapse was 26%. The actuarial 22-month disease-free survival (DFS) rate was 68% for patients in remission and 37% for patients with active disease (P < .001). Causes of death were pneumonia (n = 3), hemorrhage (n = 3), sepsis (n = 3), and relapse (n = 7). In conclusion, an MA conditioning regimen followed by haploidentical BMT with PT-CY results in a low risk of aGVHD and cGVHD and encouraging rates of TRM and DFS.<br /> (Copyright © 2013 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Acute Disease
Adolescent
Adult
Aged
Antineoplastic Agents administration & dosage
Antineoplastic Agents adverse effects
Busulfan administration & dosage
Busulfan adverse effects
Chronic Disease
Cyclophosphamide adverse effects
Disease-Free Survival
Female
Follow-Up Studies
Graft vs Host Disease etiology
Graft vs Host Disease mortality
Graft vs Host Disease prevention & control
Humans
Immunosuppressive Agents adverse effects
Male
Middle Aged
Myeloablative Agonists administration & dosage
Myeloablative Agonists adverse effects
Retrospective Studies
Survival Rate
Thiotepa administration & dosage
Thiotepa adverse effects
Transplantation, Homologous
Vidarabine administration & dosage
Vidarabine adverse effects
Vidarabine analogs & derivatives
Whole-Body Irradiation
Bone Marrow Transplantation
Cyclophosphamide administration & dosage
Hematologic Neoplasms mortality
Hematologic Neoplasms therapy
Immunosuppressive Agents administration & dosage
Transplantation Conditioning
Subjects
Details
- Language :
- English
- ISSN :
- 1523-6536
- Volume :
- 19
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation
- Publication Type :
- Academic Journal
- Accession number :
- 22940057
- Full Text :
- https://doi.org/10.1016/j.bbmt.2012.08.014