title: Salvage transplantation for allograft failure using fludarabine and alemtuzumab as conditioning regimen.
abstract: Graft failure after allogeneic blood or marrow transplantation, although generally uncommon, can be a devastating complication. This report includes the outcome of nine patients who received a salvage transplant for failure to engraft after one (n=8) or 2 (n=1) prior transplants. Eight patients received allografts from the original donor. All received fludarabine 30 mg/m(2) i.v. and alemtuzumab 20 mg i.v. daily from days -6 to -2. Daily CYA was begun on day -2, and the allograft was infused on day 0. The therapy was well tolerated with low toxicity, and all nine patients engrafted, recovering neutrophils at a median of 12 days after transplant. Four patients died: two of relapse, one of a fungal infection in the setting of GVHD and one of multiple sclerosis. The combination of fludarabine and alemtuzumab is an effective and well-tolerated salvage conditioning regimen for patients who experience graft failure after blood or marrow transplants.
authors.affiliation: Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins and The Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA. fbolano2@jhmi.edu
authors.forename: J
authors.initials: J
authors.lastname: Bolaños-Meade
authors.forename: L
authors.initials: L
authors.lastname: Luznik
authors.forename: M
authors.initials: M
authors.lastname: Muth
authors.forename: W H
authors.initials: WH
authors.lastname: Matsui
authors.forename: C A
authors.initials: CA
authors.lastname: Huff
authors.forename: B D
authors.initials: BD
authors.lastname: Smith
authors.forename: M Y
authors.initials: MY
authors.lastname: Levy
authors.forename: Y L
authors.initials: YL
authors.lastname: Kasamon
authors.forename: L J
authors.initials: LJ
authors.lastname: Swinnen
authors.forename: J D
authors.initials: JD
authors.lastname: Powell
authors.forename: R A
authors.initials: RA
authors.lastname: Brodsky
authors.forename: R F
authors.initials: RF
authors.lastname: Ambinder
authors.forename: R J
authors.initials: RJ
authors.lastname: Jones
authors.forename: E J
authors.initials: EJ
authors.lastname: Fuchs
mesh_terms: D000328:Adult; D000074323:Alemtuzumab; D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D061067:Antibodies, Monoclonal, Humanized; D000912:Antibodies, Neoplasm / Q000008:administration & dosage*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D016026:Bone Marrow Transplantation / Q000379:methods*; D005260:Female; D006084:Graft Rejection; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods; D019172:Transplantation Conditioning / Q000379:methods*; D016896:Treatment Outcome; D014740:Vidarabine / Q000008:administration & dosage / Q000031:analogs & derivatives*
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000912:Antibodies, Neoplasm; D007166:Immunosuppressive Agents; D000074323:Alemtuzumab; D014740:Vidarabine; C024352:fludarabine