title: Allogeneic hematopoietic stem-cell transplantation after nonmyeloablative preparative regimens: impact of pretransplantation and posttransplantation factors on outcome.
abstract: OBJECTIVE
  To analyze the impact of pre- and posttransplantation factors on the outcome of allogeneic transplantation after nonmyeloablative conditioning regimens.
  
  
  METHODS
  Ninety-two allogeneic transplantations after nonmyeloablative preparative regimens were reported to the Société Française de Greffe de Moelle Registry registry. Initial diagnoses were lymphoid diseases (n = 22), myeloma (n = 14), acute leukemia and myelodysplasia (n = 41), chronic myelogenous leukemia (n = 12), and solid tumors (n = 3). Forty-six patients had previously received a transplant, and 49 had progressive disease before transplantation. Three types of conditioning regimens were used with fludarabine or antithymocyte globulins. Eighty-nine patients underwent transplantation, 60 from peripheral-blood progenitor cells. Eighty-six patients received graft-versus-host disease (GHVD) prophylaxis for a median duration of 53 days.
  
  
  RESULTS
  Seventy-nine patients engrafted, with 40 complete and 21 mixed chimerisms. The acute GHVD rate at 3 months was 50% +/- 11%. Fifty-two patients achieved complete remission and 12, partial remission. At 18 months after transplantation, the overall survival (OS) and the transplant-related mortality (TRM) were 32% +/- 12% and 38% +/- 14%, respectively. Initial diagnosis and disease status before transplantation significantly influenced survival. Age and GHVD prophylaxis type significantly influenced TRM. We also showed an impact of GHVD prophylaxis duration on OS and TRM. In multivariate analysis, three factors remained of prognostic value on OS: initial diagnosis, disease status at transplantation, and GHVD prophylaxis duration.
  
  
  CONCLUSIONS
  This series shows encouraging results from nonmyeloablative conditioning regimens before allotransplantation and demonstrates the impact of some pre- and posttransplantation factors on outcome after transplantation.
authors.affiliation: Société Française de Greffe de Moelle Registry, Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Michallet
authors.forename: K
authors.initials: K
authors.lastname: Bilger
authors.forename: F
authors.initials: F
authors.lastname: Garban
authors.forename: M
authors.initials: M
authors.lastname: Attal
authors.forename: A
authors.initials: A
authors.lastname: Huyn
authors.forename: D
authors.initials: D
authors.lastname: Blaise
authors.forename: N
authors.initials: N
authors.lastname: Milpied
authors.forename: P
authors.initials: P
authors.lastname: Moreau
authors.forename: P
authors.initials: P
authors.lastname: Bordigoni
authors.forename: M
authors.initials: M
authors.lastname: Kuentz
authors.forename: A
authors.initials: A
authors.lastname: Sadoun
authors.forename: J Y
authors.initials: JY
authors.lastname: Cahn
authors.forename: G
authors.initials: G
authors.lastname: Socié
authors.forename: X
authors.initials: X
authors.lastname: Thomas
authors.forename: P
authors.initials: P
authors.lastname: Arnaud
authors.forename: N
authors.initials: N
authors.lastname: Raus
authors.forename: V
authors.initials: V
authors.lastname: Lhéritier
authors.forename: A
authors.initials: A
authors.lastname: Pigneux
authors.forename: J M
authors.initials: JM
authors.lastname: Boiron
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D006086:Graft vs Host Disease; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000628:therapy; D012074:Remission Induction; D012189:Retrospective Studies; D016019:Survival Analysis; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous; D016896:Treatment Outcome