Conditioning with targeted busulfan and cyclophosphamide for hemopoietic stem cell transplantation from related and unrelated donors in patients with myelodysplastic syndrome.
A total of 109 patients (aged 6-66 years; median, 46 years) with myelodysplastic syndrome (MDS) were treated with busulfan (BU) targeted to plasma concentrations of 800 to 900 ng/mL plus cyclophosphamide (CY), 2 x 60 mg/kg, and hemopoietic stem cell (HSC) transplantation from related (n = 45) or unrelated donors (n = 64). At the time of transplantation, 69 patients had less than 5% myeloblasts in the marrow, and 40 patients had more advanced disease. All but 2 evaluable patients had engraftment. The Kaplan-Meier estimates of 3-year relapse-free survival (RFS) were 56% for related and 59% for unrelated recipients. The cumulative incidences of relapse were 16% for related and 11% for unrelated recipients. Nonrelapse mortality (NRM) at 100 days (3 years) was 12% (28%) for related and 13% (30%) for unrelated recipients. The only factor significant for RFS was the etiology of MDS (de novo better than treatment related; P =.03). Factors significantly correlated with relapse were advanced French-American-British classification (P =.002) and International Prognostic Scoring System score (P =.009), poor-risk cytogenetics (P =.03), and treatment-related etiology (P =.03). None of the factors examined was statistically significant for NRM. Patient age and donor type had no significant impact on outcome. RFS tended to be superior in patients receiving transplants with peripheral blood rather than marrow stem cells. Thus, a targeted BUCY regimen provided effective transplant conditioning for patients with MDS receiving transplants from HLA-identical siblings or alternative donors. Although there was still considerable nonrelapse morbidity and mortality, the present regimen was used successfully even in patients older than 60 years of age.
Deeg
H Joachim
HJ
Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA. jdeeg@fhcrc.org
Storer
Barry
B
Slattery
John T
JT
Anasetti
Claudio
C
Doney
Kristine C
KC
Hansen
John A
JA
Kiem
Hans-Peter
HP
Martin
Paul J
PJ
Petersdorf
Effie
E
Radich
Jerald P
JP
Sanders
Jean E
JE
Shulman
Howard M
HM
Warren
Edus H
EH
Witherspoon
Robert P
RP
Bryant
Eileen M
EM
Chauncey
Thomas R
TR
Getzendaner
Lisa
L
Storb
Rainer
R
Appelbaum
Frederick R
FR
D000293:Adolescent; D000328:Adult; D001854:Bone Marrow Cells; D002066:Busulfan / Q000008:administration & dosage* / Q000097:blood; D002648:Child; D003520:Cyclophosphamide / Q000008:administration & dosage*; D020732:Cytogenetic Analysis; D018572:Disease-Free Survival; D005260:Female; D006086:Graft vs Host Disease; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D011379:Prognosis; D012008:Recurrence; D014019:Tissue Donors; D019172:Transplantation Conditioning / Q000379:methods*; D016896:Treatment Outcome
D003520:Cyclophosphamide; D002066:Busulfan