title: Reliable engraftment, low toxicity, and durable remissions following allogeneic blood stem cell transplantation with minimal conditioning.
abstract: OBJECTIVE
  Allogeneic blood stem cell transplantation (BSCT) can cure patients with hematologic malignancies by high-dose chemotherapy and allogeneic graft-vs-tumor (GvT) reactions. To avoid high-dose conditioning and evaluate engraftment, toxicity, and GvT reactions, we treated a group of high-risk patients with a minimal intensive conditioning regimen followed by allogeneic BSCT.
  
  
  METHODS
  Thirty-four patients with lymphoma (11), myeloma (10), chronic myeloid leukemia (4), myelodysplastic syndrome (5), and acute myeloid leukemia (4) were treated with fludarabine (3 x 30 mg/m(2)) and 200 cGy total-body irradiation followed by the infusion of peripheral blood stem cells from related (28) or unrelated (6) donors. Cyclosporine or tacrolimus and mycophenolate mofetile were given posttransplant. Most patients had advanced disease, were intensively pretreated, and had contraindications against conventional myeloablative transplantation.
  
  
  RESULTS
  Thirty-two patients (94%) had engraftment of donor cells. Patients with lymphatic malignancies developed complete donor chimerism significantly faster than patients with myeloid malignancies (p < 0.05). Clinical responses were observed in 16 of 27 patients (59%) who had active disease at transplantation. Of 7 patients who were treated in remission, 5 remain free of disease. After a median follow-up of 325 days (range 100-844) 22 patients are alive (65%, 14 CR, 4 PR, 4 PD). Two patients (6%) died of treatment-related complications and 10 patients (29%) died of progressive disease. Acute graft-vs-host-disease (GvHD) of grade II or more developed in 17 patients (50%). Chronic GvHD is present in 10 of 22 patients (45%) who are alive beyond day 100.
  
  
  CONCLUSIONS
  Toxicity and survival in this group of high-risk patients are superior to those expected with conventional allogeneic transplantation. GvT reactions frequently occur in conjunction with GvHD and can induce durable remissions in patients with advanced hematologic malignancies.
authors.affiliation: Department of Hematology, Oncology and Clinical Immunology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany. kobbe@med.uni-duesseldorf.de
authors.forename: Guido
authors.initials: G
authors.lastname: Kobbe
authors.forename: Peter
authors.initials: P
authors.lastname: Schneider
authors.forename: Manuel
authors.initials: M
authors.lastname: Aivado
authors.forename: Fabian
authors.initials: F
authors.lastname: Zohren
authors.forename: Dominique
authors.initials: D
authors.lastname: Schubert
authors.forename: Roland
authors.initials: R
authors.lastname: Fenk
authors.forename: Frank
authors.initials: F
authors.lastname: Neumann
authors.forename: Ralf
authors.initials: R
authors.lastname: Kronenwett
authors.forename: Hildegard
authors.initials: H
authors.lastname: Pape
authors.forename: Astrid
authors.initials: A
authors.lastname: Rong
authors.forename: Brigitte
authors.initials: B
authors.lastname: Royer-Pokora
authors.forename: Barbara
authors.initials: B
authors.lastname: Hildebrandt
authors.forename: Ulrich
authors.initials: U
authors.lastname: Germing
authors.forename: Norbert
authors.initials: N
authors.lastname: Gattermann
authors.forename: Axel
authors.initials: A
authors.lastname: Heyll
authors.forename: Rainer
authors.initials: R
authors.lastname: Haas
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018450:Disease Progression; D005240:Feasibility Studies; D005260:Female; D006085:Graft Survival; D006086:Graft vs Host Disease / Q000453:epidemiology / Q000209:etiology; D020544:Graft vs Leukemia Effect; D020350:Graft vs Tumor Effect; D019337:Hematologic Neoplasms / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007951:Leukemia, Myeloid / Q000628:therapy; D008223:Lymphoma / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000628:therapy; D009190:Myelodysplastic Syndromes / Q000628:therapy; D036102:Peripheral Blood Stem Cell Transplantation / Q000009:adverse effects / Q000401:mortality; D012074:Remission Induction; D012306:Risk; D016879:Salvage Therapy; D018183:Transplantation Chimera; D019172:Transplantation Conditioning / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D014184:Transplantation, Homologous / Q000009:adverse effects / Q000401:mortality; D016896:Treatment Outcome; D014916:Whole-Body Irradiation / Q000009:adverse effects