Graft versus host disease after stem cell allotransplantation with low-dose total body irradiation, fludarabine, and antithymocyte globulin.
BACKGROUND
We previously showed that antithymocyte globulin (ATG) given with total body irradiation (TBI) 200 cGy and fludarabine results in high rate of donor engraftment. Its influence on acute and chronic graft versus host disease (GVHD) and on graft versus tumor effect is less known.


METHODS
Sixty-five patients underwent nonmyeloablative stem cell transplant with ATG, TBI 200 cGy, and fludarabine. GVHD prophylaxis was mycophenolate mofetil and cyclosporine. Forty-two patients (pts) (65%) had match related donors, 18 (27%) match unrelated, 1 (1.5%) mismatch related, and 4 (6%) mismatch unrelated donors.


RESULTS
At a median follow-up of 862 days, 24 patients (37%) developed GVHD. The median age of the patients with and without GVHD was 56 years respectively. Acute GVHD grade II-IV developed in 19 pts (29%). Fatal GVHD of liver and/or gut occurred in nine pts (14%). Forty-one pts survived more than 100 days. Five pts (12%) had chronic GVHD, two had extensive, and three had limited involvement. Relapsed disease was observed in 22 pts (34%). Infections occurred in 15 pts (23%) and were fatal in 13 (20%).


CONCLUSIONS
The addition of ATG to TBI 200cGy and fludarabine resulted in a modest incidence of GVHD. The best transplant outcomes were observed in pts with lymphoid malignancies.
Grosskreutz
Celia
C
Stem Cell and Bone Marrow Transplantation Program, Division of Hematology/Oncology, Department of Medicine, Mount Sinai Medical Center, New York, NY 10029, USA. Celia.Grosskreutz@msnyuhealth.org
Scigliano
Eileen
E
Osman
Keren
K
Isola
Luis
L
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000961:Antilymphocyte Serum / Q000494:pharmacology*; D002908:Chronic Disease; D005260:Female; D006086:Graft vs Host Disease / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D033581:Stem Cell Transplantation; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014740:Vidarabine / Q000031:analogs & derivatives* / Q000494:pharmacology; D014916:Whole-Body Irradiation
D000961:Antilymphocyte Serum; D014740:Vidarabine; C024352:fludarabine