title: Non-myeloablative allografting from human leucocyte antigen-identical sibling donors for treatment of acute myeloid leukaemia in first complete remission.
abstract: Many patients with acute myeloid leukaemia (AML) in first complete remission (CR1) are ineligible for allogeneic transplantation as a result of age or medical problems other than leukaemia. Eighteen patients (median age 59 years, range 36-73 years) with de novo (n = 13) and secondary (n = 5) AML in morphological CR1, who were not candidates for conventional allografting, received non-myeloablative peripheral blood stem cell transplants from human leucocyte antigen identical sibling donors after conditioning with 2 Gy total body irradiation (TBI; n = 10) or 2 Gy TBI and 90 mg/m2 of fludarabine (n = 8). Postgrafting immunosuppression was with cyclosporine and mycophenolate mofetil. Two rejections were observed in patients not given fludarabine and one died with relapse. Overall, 10 patients died between 77 and 841 d, seven from relapse and three from non-relapse mortality (NRM). Day +100 NRM was 0% with a 1-year estimated NRM of 17%[95% confidence interval (CI) 0-35%]. The median follow-up among the eight survivors was 766 d (range, 188-1141 d). Seven of these eight survivors remain in complete remission (CR). One-year estimates of overall and progression-free survivals were 54% (95% CI 31-78%) and 42% (95% CI 19-66%) respectively. While follow-up is short, this analysis demonstrates that the procedure is sufficiently safe to be studied in a wider group of patients.
authors.affiliation: Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA.
authors.forename: Lyle C
authors.initials: LC
authors.lastname: Feinstein
authors.forename: Brenda M
authors.initials: BM
authors.lastname: Sandmaier
authors.forename: Ute
authors.initials: U
authors.lastname: Hegenbart
authors.forename: Peter A
authors.initials: PA
authors.lastname: McSweeney
authors.forename: David G
authors.initials: DG
authors.lastname: Maloney
authors.forename: Theodore A
authors.initials: TA
authors.lastname: Gooley
authors.forename: Michael B
authors.initials: MB
authors.lastname: Maris
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Chauncey
authors.forename: Benedetto
authors.initials: B
authors.lastname: Bruno
authors.forename: Frederick R
authors.initials: FR
authors.lastname: Appelbaum
authors.forename: Dietger W
authors.initials: DW
authors.lastname: Niederwieser
authors.forename: Rainer F
authors.initials: RF
authors.lastname: Storb
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006801:Humans; D007951:Leukemia, Myeloid / Q000601:surgery*; D008875:Middle Aged; D036102:Peripheral Blood Stem Cell Transplantation / Q000379:methods*; D012074:Remission Induction; D035781:Siblings; D014184:Transplantation, Homologous; D014740:Vidarabine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D014916:Whole-Body Irradiation
chemical_list: D000970:Antineoplastic Agents; D014740:Vidarabine; C024352:fludarabine