title: Hematopoietic cell transplantation from HLA-identical sibling donors after low-dose radiation-based conditioning for treatment of CML.
abstract: A total of 24 patients (median age 58; range, 27-71 years) with chronic myeloid leukemia (CML) in first chronic (CP1) (n=14), second chronic (n=4), or accelerated phase (n=6) who were not candidates for conventional hematopoietic cell transplantation (HCT), received nonmyeloablative HCT from HLA-matched siblings a median of 28.5 (range, 11-271) months after diagnosis. They were conditioned with 2 Gy total body irradiation (TBI) alone (n=8) or combined with fludarabine, 90 mg/m(2) (n=16). Postgrafting immunosuppression included cyclosporine and mycophenolate mofetil. All patients initially engrafted. However, 4 of 8 patients not given fludarabine experienced nonfatal rejection while all others had sustained engraftment. With a median follow-up of 36 (range, 4-49) months, 13 of 24 patients (54%) were alive and in complete remission. There were five (21%) deaths from nonrelapse mortality, one (4%) during the first 100 days after transplant. The proportions of grade II, III, and IV acute GVHD were 38, 4, and 8%, respectively. The 2-year estimate of chronic GVHD was 32%. The 2-year survival estimates for patients in CP1 (n=14) and beyond CP1 (n=10) were 70 and 56%, respectively. This study shows encouraging remission rates for patients with CML not eligible for conventional allografting.
authors.affiliation: Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
authors.forename: F R
authors.initials: FR
authors.lastname: Kerbauy
authors.forename: R
authors.initials: R
authors.lastname: Storb
authors.forename: U
authors.initials: U
authors.lastname: Hegenbart
authors.forename: T
authors.initials: T
authors.lastname: Gooley
authors.forename: J
authors.initials: J
authors.lastname: Shizuru
authors.forename: H K
authors.initials: HK
authors.lastname: Al-Ali
authors.forename: J P
authors.initials: JP
authors.lastname: Radich
authors.forename: D G
authors.initials: DG
authors.lastname: Maloney
authors.forename: E
authors.initials: E
authors.lastname: Agura
authors.forename: B
authors.initials: B
authors.lastname: Bruno
authors.forename: E M
authors.initials: EM
authors.lastname: Epner
authors.forename: T R
authors.initials: TR
authors.lastname: Chauncey
authors.forename: K G
authors.initials: KG
authors.lastname: Blume
authors.forename: D
authors.initials: D
authors.lastname: Niederwieser
authors.forename: B M
authors.initials: BM
authors.lastname: Sandmaier
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology / Q000401:mortality; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000401:mortality; D006650:Histocompatibility Testing; D006801:Humans; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011829:Radiation Dosage; D035781:Siblings; D014019:Tissue Donors; D018183:Transplantation Chimera; D019172:Transplantation Conditioning / Q000379:methods* / Q000401:mortality; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014740:Vidarabine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D014916:Whole-Body Irradiation / Q000379:methods
chemical_list: D000970:Antineoplastic Agents; D014740:Vidarabine; C024352:fludarabine