Impact of graft-versus-host disease in reduced-intensity stem cell transplantation (RIST) for patients with haematological malignancies.
To clarify the impact of graft-versus-host disease (GVHD) on the outcome of reduced-intensity stem cell transplantation (RIST), 40 patients who received RIST were compared with those who received conventional stem cell transplantation (CST). RIST regimens consisted of either cladribine (0.11 mg/kg/d x 6, n = 13) or fludarabine (30 mg/m(2)/d x 6, n = 27) with busulphan (BU, 4 mg/kg/d orally x 2), with or without antithymocyte globulin (ATG). CST regimens were either cyclophosphamide/total body irradiation (CY/TBI, n = 23), BU/CY (n = 19) or others (n = 6). The RIST group contained more patients who were at high risk of transplant-related mortality, including older patients, while the two groups contained the same percentages of patients at high risk of relapse. There were no differences between these groups in the incidences of acute (grade II-IV, 31.6% RIST vs 33.3% CST, P = 0.6742) and chronic GVHD (56.2%vs 64.1%, P = 0.8512), relapse rate (15.0%vs 18.8%, P = 0.6642), or overall (69.3%vs 65.6%, P = 0.4817) and progression-free survival (64.7%vs 63.8%, P = 0.6920) at d 500. Multivariate analysis of progression-free survival identified only grade III-IV acute GVHD and relapse risk dose as adverse risk factors. Although GVHD is a major threat in RIST, appropriate induction of GVHD may be associated with anti-tumour activity in RIST comparable to that of CST.
Mineishi
Shin
S
Haematopoietic Stem Cell Transplant Unit, National Cancer Centre Hospital, Tokyo, Japan. shin.mineishi@vanderbilt.edu
Kanda
Yoshinobu
Y
Saito
Takeshi
T
Nakai
Kunihisa
K
Makimoto
Atsushi
A
Kami
Masahiro
M
Tanosaki
Ryuji
R
Wakasugi
Hiro
H
Tobinai
Kensei
K
Takaue
Yoichi
Y
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D002066:Busulfan / Q000627:therapeutic use; D002908:Chronic Disease; D017338:Cladribine / Q000627:therapeutic use; D003520:Cyclophosphamide / Q000627:therapeutic use; D018572:Disease-Free Survival; D006086:Graft vs Host Disease / Q000401:mortality* / Q000517:prevention & control; D019337:Hematologic Neoplasms / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008875:Middle Aged; D016016:Proportional Hazards Models; D012008:Recurrence; D033581:Stem Cell Transplantation / Q000379:methods*; D015996:Survival Rate; D013954:Thyroglobulin / Q000627:therapeutic use; D019172:Transplantation Conditioning / Q000379:methods*; D014740:Vidarabine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D014916:Whole-Body Irradiation
D007166:Immunosuppressive Agents; D017338:Cladribine; D003520:Cyclophosphamide; D013954:Thyroglobulin; D014740:Vidarabine; D002066:Busulfan; C024352:fludarabine