Reduced-intensity preparative regimen and allogeneic stem cell transplantation for advanced solid tumors.
In this prospective multicenter program, we investigated allogeneic stem cell transplantation (ASCT) from HLA-identical siblings following reduced-intensity conditioning (RIC) regimen for patients with refractory metastatic solid tumors (STs). Fifty-seven patients, of whom 39 had a progressive disease (PD) at time of ASCT, received an RIC ASCT combining fludarabine, antithymocyte globulin (ATG), and busulfan. Patients were analyzed in terms of engraftment, transplant-related mortality (TRM), disease response, and outcome. In this setting, RIC was associated with rapid engraftment and low overall TRM (9% [95% confidence interval (CI), 1%-16%]). The cumulative incidence of objective responses (ORs) reached 14% (95% CI, 6%-30%) with this being significantly higher in patients without PD (44% [95% CI, 21%-67%] versus 0; P <.0001) at time of ASCT. Achievement of OR translated into a significantly better overall survival (OS). In multivariate analysis, OS was significantly influenced by disease status at time of ASCT (odds ratio, 4.88; P <.001) and chronic graft-versus-host disease (GVHD) occurrence (odds ratio, 2.86; P <.01). Overall, these results showed that OR can occur after RIC ASCT for resistant ST with a relatively low TRM and potential benefit especially in patients with slowly progressive disease. Further studies are warranted in patients with less advanced ST.
Blaise
Didier
D
UTTC, Institut Paoli-Calmettes, 232 Bd Ste Marguerite, 13273 Marseille Cedex 09, France. uttc@marseille.fnclcc.fr
Bay
Jacques Olivier
JO
Faucher
Catherine
C
Michallet
Mauricette
M
Boiron
Jean-Michel
JM
Choufi
Bachra
B
Cahn
Jean-Yves
JY
Gratecos
Nicole
N
Sotto
Jean-Jacques
JJ
François
Sylvie
S
Fleury
Joel
J
Mohty
Mohamad
M
Chabannon
Christian
C
Bilger
Karin
K
Gravis
Gwenaelle
G
Viret
Frédéric
F
Braud
Anne Chantal
AC
Bardou
Valérie Jeanne
VJ
Maraninchi
Dominique
D
Viens
Patrice
P
D000208:Acute Disease; D000328:Adult; D000961:Antilymphocyte Serum / Q000627:therapeutic use; D016026:Bone Marrow Transplantation / Q000401:mortality; D002066:Busulfan / Q000627:therapeutic use; D002908:Chronic Disease; D018450:Disease Progression; D005260:Female; D006086:Graft vs Host Disease / Q000453:epidemiology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009369:Neoplasms / Q000145:classification / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D035781:Siblings; D033581:Stem Cell Transplantation / Q000401:mortality; D016019:Survival Analysis; D014019:Tissue Donors; D019172:Transplantation Conditioning / Q000379:methods*; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014740:Vidarabine / Q000031:analogs & derivatives* / Q000627:therapeutic use
D000961:Antilymphocyte Serum; D007166:Immunosuppressive Agents; D014740:Vidarabine; D002066:Busulfan; C024352:fludarabine