title: Treatment for acute myelogenous leukemia by low-dose, total-body, irradiation-based conditioning and hematopoietic cell transplantation from related and unrelated donors.
abstract: OBJECTIVE
  The use of low-dose, irradiation-based preparative regimens have allowed the extension of allografting to older and medically infirm patients. The study reported here assessed outcomes for patients with acute myeloid leukemia (AML) in different stages of their disease, who were not considered candidates for conventional hematopoietic cell transplantation (HCT) because of age and/or other known risk factors and were given minimal conditioning followed by HCT from related or unrelated donors.
  
  
  METHODS
  The present study included 122 patients with AML, who were conditioned with 2 Gy total-body irradiation (TBI) on day 0 with or without preceding fludarabine (30 mg/m2/d from days -4 to -2), and given postgrafting cyclosporine at 6.25 mg/kg twice daily from day -3 and mycophenolate mofetil at 15 mg/kg twice daily from day 0.
  
  
  RESULTS
  Durable engraftment was observed in 95% of the patients. Cumulative incidences of acute graft-versus-host disease grades 2 to 4 at 6 months were 35% after related and 42% after unrelated HCT, respectively. With a median follow-up of 44 months (range, 26 to 79 months), 51 patients were alive, of whom 48 were in complete remission (CR). Cumulative nonrelapse mortalities were 10% and 22%, and cumulative mortalities from disease progression were 47% and 33% at 2 years for related and unrelated recipients, respectively. Overall, 2-year survival was 48%, and disease-free survival was 44%. Patients receiving transplantation in CR1 had 2-year overall survivals of 44% after related and 63% after unrelated HCT, respectively.
  
  
  CONCLUSIONS
  We conclude that HCT from related and unrelated donors after low-dose TBI is a promising treatment for elderly patients with AML.
authors.affiliation: University of Leipzig, Leipzig, Germany.
authors.forename: Ute
authors.initials: U
authors.lastname: Hegenbart
authors.forename: Dietger
authors.initials: D
authors.lastname: Niederwieser
authors.forename: Brenda M
authors.initials: BM
authors.lastname: Sandmaier
authors.forename: Michael B
authors.initials: MB
authors.lastname: Maris
authors.forename: Judith A
authors.initials: JA
authors.lastname: Shizuru
authors.forename: Hildegard
authors.initials: H
authors.lastname: Greinix
authors.forename: Catherine
authors.initials: C
authors.lastname: Cordonnier
authors.forename: Bernard
authors.initials: B
authors.lastname: Rio
authors.forename: Alois
authors.initials: A
authors.lastname: Gratwohl
authors.forename: Thoralf
authors.initials: T
authors.lastname: Lange
authors.forename: Haifa
authors.initials: H
authors.lastname: Al-Ali
authors.forename: Barry
authors.initials: B
authors.lastname: Storer
authors.forename: David
authors.initials: D
authors.lastname: Maloney
authors.forename: Peter
authors.initials: P
authors.lastname: McSweeney
authors.forename: Thomas
authors.initials: T
authors.lastname: Chauncey
authors.forename: Ed
authors.initials: E
authors.lastname: Agura
authors.forename: Benedetto
authors.initials: B
authors.lastname: Bruno
authors.forename: Richard T
authors.initials: RT
authors.lastname: Maziarz
authors.forename: Finn
authors.initials: F
authors.lastname: Petersen
authors.forename: Rainer
authors.initials: R
authors.lastname: Storb
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016572:Cyclosporine / Q000008:administration & dosage; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000453:epidemiology / Q000517:prevention & control; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D015994:Incidence; D015470:Leukemia, Myeloid, Acute / Q000532:radiotherapy / Q000601:surgery*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives; D011879:Radiotherapy Dosage; D016019:Survival Analysis; D013997:Time Factors; D019172:Transplantation Conditioning / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome; D014916:Whole-Body Irradiation / Q000009:adverse effects
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine; D009173:Mycophenolic Acid