title: [Allogeneic blood stem cell transplantation in high-risk patients after conditioning with treosulfan and fludarabine].
abstract: OBJECTIVE
  Allogeneic transplantation can not be offered to many patients due to potential side-effects of conventional conditioning. Dose-reduced conditioning approaches improve tolerability, however, treatment efficacy may be reduced as well. We have, therefore, developed a dose intense but toxicity reduced conditioning regimen based on treosulfan and fludarabine and report first results.
  
  
  METHODS
  65 patients with a median age of 50 years were transplanted from related (n = 21) or unrelated donors (n = 44) after conditioning with treosulfan (3 x 10, 3 x 12 or 3 x 14 g/m(2) i. v.) and fludarabine (5 x 30 mg/m(2) i. v.). 21 patients were in complete remission (CR) and 44 patients had not reached a CR at the time of transplantation. 59 of 65 patients were considered unfit for a conventional conditioning regimen.
  
  
  RESULTS
  The actuarial overall survival after 3 years is 59.2 %, the event-free survival 40.1 %. Patients with a related donor or transplantation in CR had a better overall (85.4 resp. 74.2 %) and event-free survival (52.2 % resp. 61.9 %). The cumulative incidence of relapse at 3 years was 26.2 %. Non-relapse mortality at day 100 is 17.4 % (cumulative incidence). In stepwise Cox regression analyses for overall survival, event-free survival and non-relapse mortality the covariables transplantation in CR vs. not in CR and the donor status were shown to be influential.
  
  
  CONCLUSIONS
  These results with a conditioning therapy of treosulfan and fludarabine indicate that patients despite higher age, concomitant disease or after intensive pretreatment can be successfully transplanted without increased treatment-related mortality.
authors.affiliation: Abteilung Hämatologie und Onkologie der Medizinischen Fakultät der Universität Rostock. jochen.casper@med.uni-rostock.de
authors.forename: J
authors.initials: J
authors.lastname: Casper
authors.forename: S
authors.initials: S
authors.lastname: Wilhelm
authors.forename: B
authors.initials: B
authors.lastname: Steiner
authors.forename: D
authors.initials: D
authors.lastname: Wolff
authors.forename: N
authors.initials: N
authors.lastname: Grobe
authors.forename: D
authors.initials: D
authors.lastname: Hähling
authors.forename: G
authors.initials: G
authors.lastname: Hartung
authors.forename: I
authors.initials: I
authors.lastname: Hilgendorf
authors.forename: A
authors.initials: A
authors.lastname: Lück
authors.forename: C
authors.initials: C
authors.lastname: Junghanss
authors.forename: C
authors.initials: C
authors.lastname: Kahl
authors.forename: J
authors.initials: J
authors.lastname: Baumgart
authors.forename: U
authors.initials: U
authors.lastname: Pichlmeier
authors.forename: M
authors.initials: M
authors.lastname: Freund
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage / Q000627:therapeutic use; D002066:Busulfan / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D018572:Disease-Free Survival; D004305:Dose-Response Relationship, Drug; D005260:Female; D006086:Graft vs Host Disease / Q000453:epidemiology; D019337:Hematologic Neoplasms / Q000401:mortality / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods* / Q000401:mortality / Q000592:standards; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012044:Regression Analysis; D012074:Remission Induction; D012307:Risk Factors; D016019:Survival Analysis; D019172:Transplantation Conditioning / Q000379:methods* / Q000401:mortality / Q000592:standards; D014184:Transplantation, Homologous; D014740:Vidarabine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D000970:Antineoplastic Agents; D018906:Antineoplastic Agents, Alkylating; C018404:treosulfan; D014740:Vidarabine; D002066:Busulfan; C024352:fludarabine