title: Unrelated donor hematopoietic stem cell transplantation for patients with hematologic malignancies using a nonmyeloablative conditioning regimen of fludarabine, low-dose total body irradiation, and rabbit antithymocyte globulin.
abstract: Hematopoietic stem cell chimerism can be established after low-dose conditioning regimens, although the risk of donor cell rejection increases for unrelated donor transplantations. We added pretransplantation rabbit antithymocyte globulin (6 mg/kg) to an established conditioning regimen of fludarabine (90 mg/m2) and single-fraction total body irradiation (200 cGy) followed by postgrafting immunosuppression with cyclosporine A and mycophenolate mofetil for 22 patients with hematologic malignancies. One patient rejected the graft and successfully underwent transplantation with cells from a second donor by using the same conditioning regimen. The actuarial probability of developing acute graft-versus-host disease grade II to IV before day 100 was 40%, although 9 of 14 patients who survived beyond 100 days developed chronic graft-versus-host disease. These data support a hypothesis that the addition of antithymocyte globulin decreases the risk of graft-versus-host and host-versus-graft reactions when combined with a nonmyeloablative conditioning regimen of fludarabine and total body irradiation.
authors.affiliation: Adult Blood and Marrow Transplant Program, Hackensack University Medical Center, Hackensack, New Jersey 07601, USA. srowley@humed.com
authors.forename: Scott D
authors.initials: SD
authors.lastname: Rowley
authors.forename: Stuart L
authors.initials: SL
authors.lastname: Goldberg
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Pecora
authors.forename: Jack S
authors.initials: JS
authors.lastname: Hsu
authors.forename: Barbara Adler
authors.initials: BA
authors.lastname: Brecher
authors.forename: Linda
authors.initials: L
authors.lastname: Butrin
authors.forename: Kelly
authors.initials: K
authors.lastname: Kobbe
authors.forename: Phyllis
authors.initials: P
authors.lastname: McKiernan
authors.forename: Robert
authors.initials: R
authors.lastname: Preti
mesh_terms: D000328:Adult; D000368:Aged; D000961:Antilymphocyte Serum / Q000008:administration & dosage; D005260:Female; D006084:Graft Rejection / Q000517:prevention & control; D006086:Graft vs Host Disease / Q000517:prevention & control*; D019337:Hematologic Neoplasms / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D019172:Transplantation Conditioning / Q000379:methods*; D014740:Vidarabine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D014916:Whole-Body Irradiation
chemical_list: D000961:Antilymphocyte Serum; D007166:Immunosuppressive Agents; D014740:Vidarabine; C024352:fludarabine