title: Reduced-intensity conditioning with busulfan and fludarabine with or without antithymocyte globulin in HLA-identical sibling transplantation--a retrospective analysis.
abstract: It is unknown whether the addition of antithymocyte globulin (ATG) to reduced-intensity conditioning with busulfan (BU) and fludarabine (FLU) is beneficial in HLA-identical sibling transplantation. Therefore, we analyzed retrospectively data on 83 patients, who received peripheral blood stem cells from HLA-identical siblings after conditioning with either 8 mg/kg BU and 150 mg/m2 FLU (n=45) or 8 mg/kg BU, 180 mg/m2 FLU and 40 mg/kg ATG (n=38). Graft-versus-host disease (GVHD) prophylaxis consisted of CSA alone (n=32) or a combination with either MTX or MMF (n=51). The median age was 52 years. Graft failure occurred in two patients after BU/FLU and in three after BU/FLU/ATG (P=0.66). After conditioning with BU/FLU, platelet recovery was significantly faster (P=0.017), and less platelet (P<0.001) and red blood cell (P=0.002) support was needed. Incidences of acute GVHD grades II and IV were 46 and 49%, respectively. Limited chronic GVHD occurred more often after BU/FLU compared to BU/FLU/ATG (54 vs 23%, P=0.02). The overall survival, non-relapse and relapse mortality did not differ significantly. We conclude that in peripheral blood stem cell transplantation from HLA-identical siblings after reduced-intensity conditioning with BU and FLU, ATG has no major impact on the rate of graft rejection and acute GVHD, but it reduces the incidence of limited chronic GVHD.
authors.affiliation: Charité Campus Virchow Klinikum, Humboldt-Universität zu Berlin, Klinik für Innere Medizin mS Hämatologie und Onkologie, Berlin, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Schetelig
authors.forename: M
authors.initials: M
authors.lastname: Bornhäuser
authors.forename: M
authors.initials: M
authors.lastname: Kiehl
authors.forename: R
authors.initials: R
authors.lastname: Schwerdtfeger
authors.forename: N
authors.initials: N
authors.lastname: Kröger
authors.forename: V
authors.initials: V
authors.lastname: Runde
authors.forename: T
authors.initials: T
authors.lastname: Zabelina
authors.forename: T K
authors.initials: TK
authors.lastname: Held
authors.forename: C
authors.initials: C
authors.lastname: Thiede
authors.forename: A A
authors.initials: AA
authors.lastname: Fauser
authors.forename: D
authors.initials: D
authors.lastname: Beelen
authors.forename: A
authors.initials: A
authors.lastname: Zander
authors.forename: G
authors.initials: G
authors.lastname: Ehninger
authors.forename: W
authors.initials: W
authors.lastname: Siegert
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000961:Antilymphocyte Serum / Q000008:administration & dosage*; D002066:Busulfan / Q000008:administration & dosage*; D002908:Chronic Disease; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000401:mortality; D019337:Hematologic Neoplasms / Q000188:drug therapy* / Q000401:mortality; D006410:Hematopoiesis; D018380:Hematopoietic Stem Cell Transplantation; D006650:Histocompatibility Testing; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D035781:Siblings; D016019:Survival Analysis; D019172:Transplantation Conditioning / Q000379:methods*; D014184:Transplantation, Homologous; D017211:Treatment Failure; D014740:Vidarabine / Q000008:administration & dosage* / Q000031:analogs & derivatives*
chemical_list: D000961:Antilymphocyte Serum; D007166:Immunosuppressive Agents; D014740:Vidarabine; D002066:Busulfan; C024352:fludarabine