title: Fludarabine-melphalan as a preparative regimen for reduced-intensity conditioning allogeneic stem cell transplantation in relapsed and refractory Hodgkin's lymphoma: the updated M.D. Anderson Cancer Center experience.
abstract: BACKGROUND
  The role of reduced-intensity conditioning allogeneic stem cell transplantation in relapsed/refractory Hodgkin's lymphoma remains poorly defined. We here present an update of our single-center experience with fludarabine-melphalan as a preparative regimen.
  
  
  METHODS
  Fifty-eight patients with relapsed/refractory Hodgkin's lymphoma underwent RIC and allogeneic stem cell transplantation from a matched related donor (MRD; n=25) or a matched unrelated donor (MUD; n=33). Forty-eight (83%) had undergone prior autologous stem cell transplantation. Disease status at transplant was refractory relapse (n=28) or sensitive relapse (n=30).
  
  
  RESULTS
  Cumulative day 100 and 2-year transplant-related mortality rates were 7% and 15%, respectively (day 100 transplant-related mortality MRD vs. MUD 8% vs. 6%, p=ns; 2-year MRD vs. MUD 13% vs. 16%, p=ns). The cumulative incidence of acute (grade II-IV) graft-versus-host disease in the first 100 days was 28% (MRD vs. MUD 12% vs. 39%, p=0.04). The cumulative incidence of chronic graft-versus-host disease at any time was 73% (MRD vs. MUD 57% vs. 85%, p=0.006). Projected 2-year overall and progression-free survival rates are 64% (49-76%) and 32% (20-45%), with 2-year disease progression/relapse at 55% (43-70%). There was no statistically significant differences in overall survival progression-free survival, and disease progression/relapse between MRD and MUD transplants. There was a trend for the response status pretransplant to have a favorable impact on progression-free survival (p=0.07) and disease progression/relapse (p=0.049), but not on overall survival (p=0.4)
  
  
  CONCLUSIONS
  Fludarabine-melphalan as a preparative regimen for reduced-intensity conditioning allogeneic stem cell transplantation in progression-free survival Hodgkin's lymphoma is associated with a significant reduction in transplant-related mortality, with comparable results in MRD and MUD allografts. Optimizing pretransplant response status may improve patients' outcome.
authors.affiliation: The U.T. M.D. Anderson Cancer Center, Department of Stem Cell Transplantation and Cellular Therapy 1515 Holcombe Boulevard, Unit 423, Houston, TX 77030 USA. panderli@mdanderson.org
authors.forename: Paolo
authors.initials: P
authors.lastname: Anderlini
authors.forename: Rima
authors.initials: R
authors.lastname: Saliba
authors.forename: Sandra
authors.initials: S
authors.lastname: Acholonu
authors.forename: Sergio A
authors.initials: SA
authors.lastname: Giralt
authors.forename: Borje
authors.initials: B
authors.lastname: Andersson
authors.forename: Naoto T
authors.initials: NT
authors.lastname: Ueno
authors.forename: Chitra
authors.initials: C
authors.lastname: Hosing
authors.forename: Issa F
authors.initials: IF
authors.lastname: Khouri
authors.forename: Daniel
authors.initials: D
authors.lastname: Couriel
authors.forename: Marcos
authors.initials: M
authors.lastname: de Lima
authors.forename: Muzaffar H
authors.initials: MH
authors.lastname: Qazilbash
authors.forename: Barbara
authors.initials: B
authors.lastname: Pro
authors.forename: Jorge
authors.initials: J
authors.lastname: Romaguera
authors.forename: Luis
authors.initials: L
authors.lastname: Fayad
authors.forename: Frederick
authors.initials: F
authors.lastname: Hagemeister
authors.forename: Anas
authors.initials: A
authors.lastname: Younes
authors.forename: Mark F
authors.initials: MF
authors.lastname: Munsell
authors.forename: Richard E
authors.initials: RE
authors.lastname: Champlin
mesh_terms: D000328:Adult; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006689:Hodgkin Disease / Q000401:mortality / Q000628:therapy*; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008558:Melphalan / Q000008:administration & dosage*; D008875:Middle Aged; D019653:Myeloablative Agonists / Q000008:administration & dosage*; D010865:Pilot Projects; D011446:Prospective Studies; D012008:Recurrence; D033581:Stem Cell Transplantation; D015996:Survival Rate; D014019:Tissue Donors; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous; D014740:Vidarabine / Q000008:administration & dosage / Q000031:analogs & derivatives*
chemical_list: D019653:Myeloablative Agonists; D014740:Vidarabine; C024352:fludarabine; D008558:Melphalan