title: Long-term remissions in patients with myelodysplastic syndrome and secondary acute myelogenous leukemia undergoing allogeneic transplantation following a reduced intensity conditioning regimen of 550 cGy total body irradiation and cyclophosphamide.
abstract: We analyzed outcomes of patients with myelodysplastic syndrome (MDS) or secondary acute myelogenous leukemia (sAML) that were treated at our institution with a reduced intensity conditioning (RIC) regimen of 550-cGy total body irradiation and cyclophosphamide followed by related donor (RD) or unrelated donor (URD) transplantation. Fifty-one consecutive patients with MDS or sAML received this RIC regimen and URD (n = 30) or RD (n = 21) stem cells. Graft-versus-host disease prophylaxis consisted of cyclosporine alone (RD) or with corticosteroids and methotrexate (URD). Median patient age was 44 years. With a median follow-up of 3.7 years after transplantation in the 19 surviving patients (37%), Kaplan-Meier estimates of overall survival were 88%, 46%, 33%, and 11% for patients transplanted with sAML in remission, refractory anemia, refractory anemia with excess blasts, refractory anemia with excess blasts in transformation, or sAML refractory/untreated, respectively. Kaplan-Meier estimates of relapse-free survival were 75%, 46%, 33%, and 11%, respectively. Overall, the cumulative incidences of relapse and transplant-related mortality were 27% and 37%, respectively. In patients with MDS, this is an effective RIC regimen for allogeneic transplantation that can be used as an alternative to other RIC or conventional conditioning regimens.
authors.affiliation: Department of Internal Medicine, Division of Oncology, Section of Bone Marrow Transplantation and Leukemia, St Louis, Missouri, USA.
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Hallemeier
authors.forename: Mark D
authors.initials: MD
authors.lastname: Girgis
authors.forename: William G
authors.initials: WG
authors.lastname: Blum
authors.forename: Randy A
authors.initials: RA
authors.lastname: Brown
authors.forename: Hanna J
authors.initials: HJ
authors.lastname: Khoury
authors.forename: Steven M
authors.initials: SM
authors.lastname: Devine
authors.forename: Ravi
authors.initials: R
authors.lastname: Vij
authors.forename: Hsu-san
authors.initials: HS
authors.lastname: Lin
authors.forename: John F
authors.initials: JF
authors.lastname: DiPersio
authors.forename: Douglas R
authors.initials: DR
authors.lastname: Adkins
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D016026:Bone Marrow Transplantation / Q000379:methods* / Q000401:mortality; D003520:Cyclophosphamide / Q000627:therapeutic use; D005260:Female; D006085:Graft Survival; D006086:Graft vs Host Disease / Q000209:etiology; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D019653:Myeloablative Agonists / Q000627:therapeutic use; D009190:Myelodysplastic Syndromes / Q000628:therapy*; D016609:Neoplasms, Second Primary / Q000628:therapy*; D036102:Peripheral Blood Stem Cell Transplantation / Q000379:methods* / Q000401:mortality; D011879:Radiotherapy Dosage; D012008:Recurrence; D012189:Retrospective Studies; D016019:Survival Analysis; D019172:Transplantation Conditioning / Q000379:methods*; D014916:Whole-Body Irradiation / Q000379:methods
chemical_list: D019653:Myeloablative Agonists; D003520:Cyclophosphamide