title: Nonmyeloablative stem cell transplantation for myelodysplastic syndrome or acute myeloid leukemia in patients 60 years or older.
abstract: We analyzed the outcomes of 24 consecutive patients aged >or=60 years with poor-prognosis myelodysplastic syndrome or acute myeloid leukemia undergoing transplantation with nonmyeloablative conditioning using fludarabine (125 mg/m2) and low-dose total body irradiation (2 Gy) followed by allogeneic peripheral blood stem cell grafts from HLA-identical sibling donors. Graft-versus-host disease (GVHD) prophylaxis consisted of cyclosporine and mycophenolate mofetil. The median age of the patients was 64 years (range, 60-71 years). In addition to age, 88% of patients had 1 or more adverse biological features of the disease. With a median follow-up of 21 months, 12 patients are alive, 11 of whom are disease free. The probabilities of 2-year overall and progression-free survival were 52% and 44%, respectively. The cumulative probabilities of relapse and of acute and chronic GVHD were 27%, 45%, and 74%, respectively. Nonrelapse mortality at 100 days and 2 years was 8% and 25%, respectively. Of the 15 patients with extensive chronic GVHD, 1 patient relapsed. These data suggest that nonmyeloablative stem cell transplantation is a feasible treatment option in patients aged >or=60 years with poor-prognosis myelodysplastic syndrome or acute myeloid leukemia. The reasonable disease control with nonmyeloablative transplantation in this high-risk group of patients merits further investigation.
authors.affiliation: Blood and Marrow Transplant Program, Princess Margaret Hospital, Toronto, Ontario, Canada. vikas.gupta@uhn.on.ca
authors.forename: Vikas
authors.initials: V
authors.lastname: Gupta
authors.forename: Andrew
authors.initials: A
authors.lastname: Daly
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Lipton
authors.forename: Wanda
authors.initials: W
authors.lastname: Hasegawa
authors.forename: Kathy
authors.initials: K
authors.lastname: Chun
authors.forename: Suzanne
authors.initials: S
authors.lastname: Kamel-Reid
authors.forename: Richard
authors.initials: R
authors.lastname: Tsang
authors.forename: Qi-long
authors.initials: QL
authors.lastname: Yi
authors.forename: Mark
authors.initials: M
authors.lastname: Minden
authors.forename: Hans
authors.initials: H
authors.lastname: Messner
authors.forename: Thomas
authors.initials: T
authors.lastname: Kiss
mesh_terms: D000208:Acute Disease; D000368:Aged; D005260:Female; D006085:Graft Survival; D006086:Graft vs Host Disease; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006650:Histocompatibility Testing; D006801:Humans; D007951:Leukemia, Myeloid / Q000150:complications / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000150:complications / Q000401:mortality / Q000628:therapy*; D009894:Opportunistic Infections; D035781:Siblings; D016019:Survival Analysis; D019172:Transplantation Conditioning / Q000009:adverse effects / Q000379:methods*; D014740:Vidarabine / Q000008:administration & dosage / Q000031:analogs & derivatives; D014916:Whole-Body Irradiation
chemical_list: D014740:Vidarabine; C024352:fludarabine