Allografting after nonmyeloablative conditioning as a treatment after a failed conventional hematopoietic cell transplant.
Outcomes with conventional allogeneic hematopoietic cell transplantation (HCT) after failed HCT are typically poor. To reduce transplantation-related mortality (TRM), 55 patients (median age, 43 years; range, 18-69 years) who had failed conventional autologous (n = 49), allogeneic (n = 4), or syngeneic (n = 2) HCT received human leukocyte antigen-matched related (n = 31) or unrelated (n = 24) donor allografts after nonmyeloablative conditioning with 2 Gy of total body irradiation or 2 Gy of total body irradiation and 90 mg/m(2) of fludarabine. Postgrafting immunosuppression consisted of cyclosporine and mycophenolate mofetil. One rejection occurred. Thirty-three patients died a median of 127 days (range, 7-834 days) after HCT: 21 of relapse, 11 of TRM, and 1 of suicide. The TRM rate on day 100 was 11% with an estimated 1-year TRM rate of 20% (95% confidence interval [CI], 9% to 31%). The median follow-up among the 22 survivors is 368 days (range, 173-796 days). Seventeen of 22 survivors are progression-free. One-year estimates of overall and progression-free survival rates are 49% (95% CI, 35% to 62%) and 28% (95% CI, 16% to 41%), respectively. Untreated disease at the time of allografting after nonmyeloablative conditioning increased the risk of death (hazard ratio = 2.4; P =.04). Although the length of follow-up is still short, it appears that encouraging outcomes can be achieved with nonmyeloablative conditioning in patients expected to have poor outcomes with conventional allografting.
Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington 98109-1024, USA.
Lyle C
LC
Feinstein
Brenda M
BM
Sandmaier
David G
DG
Maloney
Michael B
MB
Maris
Theodore A
TA
Gooley
Thomas R
TR
Chauncey
Ute
U
Hegenbart
Peter A
PA
McSweeney
Monic J
MJ
Stuart
Stephen J
SJ
Forman
Edward A
EA
Agura
Michael A
MA
Pulsipher
Karl G
KG
Blume
Dietger W
DW
Niederwieser
Rainer F
RF
Storb
D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000633:toxicity; D016572:Cyclosporine / Q000008:administration & dosage; D006085:Graft Survival; D019337:Hematologic Neoplasms / Q000150:complications / Q000401:mortality / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives*; D016879:Salvage Therapy; D016019:Survival Analysis; D019172:Transplantation Conditioning / Q000379:methods*; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous; D017211:Treatment Failure; D016896:Treatment Outcome; D014740:Vidarabine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D014916:Whole-Body Irradiation
D016572:Cyclosporine; D014740:Vidarabine; D009173:Mycophenolic Acid; C024352:fludarabine