Allogeneic stem-cell transplantation with fludarabine and 2-Gy TBI-based conditioning regimen for chronic hematological malignancy: a study of 25 consecutive patients and a literature review

Leuk Lymphoma. 2007 Feb;48(2):321-9. doi: 10.1080/10428190601059688.

Abstract

We analyzed the outcome of 25 consecutive patients with chronic hematological malignancy who underwent allogeneic stem-cell transplantation conditioned with fludarabine (30 mg/m2/day, thrice) and total body irradiation (2 Gy). All patients received peripheral blood stem cells from an HLA-identical sibling donor. With a median follow-up of 769 days (range, 244 - 1231), the estimated 2-year overall survival (OS), event-free survival (EFS), transplantation-related mortality and relapse rates were 53%, 45%, 27%, and 39%, respectively. All patients had initial engraftment. Acute Grade II - IV graft-versus-host disease (GVHD) was recorded in 14 patients (56%), including 7 (28%) with Grade III - IV GVHD. Sixteen of the 23 patients (70%) who survived more than 100 days developed chronic GVHD. OS and EFS were adversely influenced by acute Grade III - IV GVHD (p < 0.001 and p = 0.033, respectively), but chronic GVHD seemed to favorably influence these two parameters (p = 0.03 and p < 0.001, respectively). Patients with full-donor chimerism at day 30 had lower relapse rates, as did those who received high-dose allogeneic CD8+ lymphocytes with their graft (p = 0.026). Collectively, these results provide a framework for refining nonmyeloablative conditioning, to improve outcome with an acceptable risk of GVHD.

MeSH terms

  • Adult
  • Antineoplastic Agents / therapeutic use*
  • Combined Modality Therapy
  • DNA (Cytosine-5-)-Methyltransferases / antagonists & inhibitors
  • Female
  • Graft vs Host Disease / therapy
  • Hematologic Neoplasms / therapy*
  • Hematopoietic Stem Cell Transplantation*
  • Hematopoietic Stem Cells / drug effects
  • Humans
  • Immunosuppressive Agents / therapeutic use
  • Male
  • Middle Aged
  • Survival Rate
  • Transplantation Chimera
  • Transplantation Conditioning*
  • Transplantation, Homologous
  • Vidarabine / analogs & derivatives*
  • Vidarabine / therapeutic use
  • Whole-Body Irradiation*

Substances

  • Antineoplastic Agents
  • Immunosuppressive Agents
  • DNA (Cytosine-5-)-Methyltransferases
  • Vidarabine
  • fludarabine