Evidence for a graft-versus-leukemia effect after allogeneic peripheral blood stem cell transplantation with reduced-intensity conditioning in acute myelogenous leukemia and myelodysplastic syndromes.
We report the results of a prospective study of a reduced-intensity conditioning (RIC) regimen followed by allogeneic peripheral blood stem cell transplantation (PBSCT) from an HLA-identical sibling in 37 patients with acute myeloid leukemia (AML; n = 17) or myelodysplastic syndrome (MDS; n = 20). The median age was 57 years, and 22 (59%) were beyond the early phase of their disease. The incidence of grade II to IV acute graft-versus-host disease (GVHD) was 19% (5% grade III-IV), and the 1-year incidence of chronic extensive GVHD was 46%. With a median follow-up of 297 days (355 days in 24 survivors), the 1-year probability of transplant-related mortality was 5%, and the 1-year progression-free survival was 66%. The 1-year incidence of disease progression in patients with and without GVHD was 13% (95% CI, 4%-34%) and 58% (95% CI, 36%-96%), respectively (P =.008). These results suggest that a graft-versus-leukemia effect plays a crucial role in reducing the risk of relapse after a RIC allograft in AML and MDS.
Martino
Rodrigo
R
Division of Clinical Hematology, Hospital de la Santa Creu i Sant Pau, Av Sant Antoni Maria Claret, 167 08025 Barcelona, Spain. rmartino@hsp.santpau.es
Caballero
María Dolores
MD
Pérez-Simón
José Antonio
JA
Simón
José Antonio Pérez
JA
Canals
Carmen
C
Solano
Carlos
C
Urbano-Ispízua
Alvaro
A
Bargay
Joan
J
Léon
Angel
A
Sarrá
Josep
J
Sanz
Guillermo F
GF
Moraleda
José María
JM
Brunet
Salut
S
San Miguel
Jesús
J
Sierra
Jorge
J
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage; D002066:Busulfan / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006086:Graft vs Host Disease; D020544:Graft vs Leukemia Effect; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D015994:Incidence; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000188:drug therapy* / Q000401:mortality; D011446:Prospective Studies; D016019:Survival Analysis; D019172:Transplantation Conditioning / Q000379:methods*; D014185:Transplantation, Isogeneic / Q000009:adverse effects; D014740:Vidarabine / Q000008:administration & dosage / Q000031:analogs & derivatives
D014740:Vidarabine; D002066:Busulfan; C024352:fludarabine