title: Durable remissions of myelodysplastic syndrome and acute myeloid leukemia after reduced-intensity allografting.
abstract: OBJECTIVE
  To evaluate the use of reduced-intensity (RI) conditioning with allogeneic hematopoietic stem cell transplantation (HSCT) from HLA-identical family donors in patients with myelodysplastic syndrome (MDS) or acute myeloid leukemia (AML).
  
  
  METHODS
  Sixteen patients (median age, 54 years; range, 37 to 66 years) underwent RI-HSCT using a conditioning regimen of fludarabine 25 mg/m2 daily for 5 days and either cyclophosphamide 1 g/m2 daily for 2 days (14 patients) or melphalan 140 mg/m2 for 1 day (two patients). The median number of CD34+ cells and CD3+ cells infused per kilogram of recipient weight was 4.5 x 106 (range, 1.8 to 7.3 x 106 cells) and 2.9 x 108 (range, 0.1 to 9.6 x 108 cells), respectively.
  
  
  RESULTS
  There was no transplant-related mortality (TRM) within 100 days of HSCT. Grade 1 to 2 acute graft-versus-host disease (GVHD) occurred in three patients, but neither grade 3 nor grade 4 disease was observed. Chronic GVHD occurred in 10 patients. One patient had cytomegalovirus (CMV) reactivation but did not develop CMV disease. With a median follow-up of 26 months (range, 15 to 45 months), 11 patients are alive (nine in continuous complete remission and one in complete remission after a second transplantation), and five have died (four from disease progression and one from bone-marrow aplasia induced by cyclosporine withdrawal). The 2-year actuarial overall and event-free survival rates were 69% (95% confidence interval [CI], 40% to 86%) and 56% (95% CI, 30% to 68%), respectively.
  
  
  CONCLUSIONS
  This strategy of RI-HSCT resulted in reliable engraftment with low incidence of acute GVHD and TRM. Durable remissions were observed in patients with MDS and AML consistent with a graft-versus-leukemia effect.
authors.affiliation: Department of Medical Oncology, 45 Little Britain, St Bartholomew's Hospital, London EC1A 7BE, United Kingdom.
authors.forename: D C
authors.initials: DC
authors.lastname: Taussig
authors.forename: A J
authors.initials: AJ
authors.lastname: Davies
authors.forename: J D
authors.initials: JD
authors.lastname: Cavenagh
authors.forename: H
authors.initials: H
authors.lastname: Oakervee
authors.forename: D
authors.initials: D
authors.lastname: Syndercombe-Court
authors.forename: S
authors.initials: S
authors.lastname: Kelsey
authors.forename: J A L
authors.initials: JA
authors.lastname: Amess
authors.forename: A Z S
authors.initials: AZ
authors.lastname: Rohatiner
authors.forename: T A
authors.initials: TA
authors.lastname: Lister
authors.forename: M J
authors.initials: MJ
authors.lastname: Barnett
mesh_terms: D000208:Acute Disease; D000328:Adult; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D007951:Leukemia, Myeloid / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000628:therapy*; D019172:Transplantation Conditioning / Q000379:methods*