Safety and outcome after fludarabine-thiotepa-TBI conditioning for allogeneic transplantation: a prospective study of 30 patients with hematologic malignancies.
Fludarabine, thiotepa and total body irradiation (TBI) has been used as conditioning in haplo-identical transplantation. We studied this conditioning regimen in adults undergoing matched sibling transplantation and alternative donor transplantation. A total of 30 consecutive patients underwent matched related, haplo-identical related or matched unrelated donor transplantation with fludarabine, thiotepa and TBI conditioning. All but four had advanced hematologic malignancies. For haplo-identical transplant, ATG was added to the regimen. All patients received peripheral blood stem cells; these were T-cell depleted for 2-antigen or 3-antigen mismatched related transplantation. Additional graft-versus-host disease prophylaxis consisted of tacrolimus and mini-methotrexate. One recipient of haplo-identical transplant failed to engraft; all other evaluable patients had prompt engraftment. Four patients died of regimen-related toxicity. In all, 14 additional patients died of regimen-related causes including four from failure to thrive with persistent thrombocytopenia and four from delayed pulmonary toxicity. Six patients relapsed. Progression-free survival at 12 months was 47% (90% CI: 25-69%) for recipients of HLA-identical sibling transplants and 30% (90% CI: 14-46%) for all patients. Five of six long-term survivors have extensive chronic GVHD. As a result of the delayed complications and a relatively high recurrence rate, we abandoned this regimen.
van Besien
K
K
1University of Illinois at Chicago, Chicago, IL, USA.
Devine
S
S
Wickrema
A
A
Jessop
E
E
Amin
K
K
Yassine
M
M
Maynard
V
V
Stock
W
W
Peace
D
D
Ravandi
F
F
Chen
Y-H
YH
Cheung
T
T
Vijayakumar
S
S
Hoffman
R
R
Sosman
J
J
D000293:Adolescent; D000328:Adult; D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage / Q000633:toxicity*; D002648:Child; D003131:Combined Modality Therapy; D006085:Graft Survival; D006086:Graft vs Host Disease / Q000188:drug therapy / Q000276:immunology; D006239:Haplotypes; D019337:Hematologic Neoplasms / Q000150:complications / Q000401:mortality / Q000628:therapy*; D006648:Histocompatibility; D006801:Humans; D008875:Middle Aged; D036102:Peripheral Blood Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D016019:Survival Analysis; D013852:Thiotepa / Q000008:administration & dosage / Q000633:toxicity; D019172:Transplantation Conditioning / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D014184:Transplantation, Homologous / Q000276:immunology; D017211:Treatment Failure; D016896:Treatment Outcome; D014740:Vidarabine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000633:toxicity; D014916:Whole-Body Irradiation / Q000009:adverse effects* / Q000379:methods
D018906:Antineoplastic Agents, Alkylating; D013852:Thiotepa; D014740:Vidarabine; C024352:fludarabine