title: Promising progression-free survival for patients low and intermediate grade lymphoid malignancies after nonmyeloablative umbilical cord blood transplantation.
abstract: Nonmyeloablative hematopoietic cell transplantation (HCT) has been used to treat patients with advanced or high-risk lymphoid malignancies. We studied 65 patients (median age 46 years) receiving an umbilical cord blood (UCB) graft after a single conditioning regimen consisting of cyclophosphamide (50 mg/kg) on day -6, fludarabine (40 mg/m(2)) daily on days -6 to -2, as well as a single fraction of total-body irradiation (TBI) (200 cGy) along with cyclosporine mycophenolate mofetil immunosuppression. Median time to neutrophil and platelet recovery was 7.5 days (range: 0-32) and 46 days (range: 8-111), respectively. Cumulative incidences of grade II-IV, grade III-IV acute, and chronic graft-versus-host disease (aGVHD, cGVHD) were 57% (95% confidence interval [CI]: 43%-70%), 25% (95% CI: 14%-35%), and 19% (95% CI: 9%-29%), respectively. Transplant-related mortality at 3 years was 15% (95% CI: 5%-26%). Median follow-up was 23 months. The progression free-survival (PFS), current PFS and overall survival (OS) were 34% (95% CI: 21%-47%), 49% (95% CI: 36%-62%), and 55% (95% CI: 42%-70%) at 3 years. Based on our data, we conclude that a nonmyeloablative conditioning regimen followed by UCB transplantation is an effective treatment for patients with advanced lymphoid malignancies who lack a suitable sibling donor.
authors.affiliation: University of Minnesota Blood and Marrow Transplant Program, Minneapolis, Minnesota, USA. bruns072@umn.edu
authors.forename: Claudio G
authors.initials: CG
authors.lastname: Brunstein
authors.forename: Susana
authors.initials: S
authors.lastname: Cantero
authors.forename: Qing
authors.initials: Q
authors.lastname: Cao
authors.forename: Navneet
authors.initials: N
authors.lastname: Majhail
authors.forename: Brian
authors.initials: B
authors.lastname: McClune
authors.forename: Linda J
authors.initials: LJ
authors.lastname: Burns
authors.forename: Marcie
authors.initials: M
authors.lastname: Tomblyn
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Miller
authors.forename: Bruce R
authors.initials: BR
authors.lastname: Blazar
authors.forename: Philip B
authors.initials: PB
authors.lastname: McGlave
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Weisdorf
authors.forename: John E
authors.initials: JE
authors.lastname: Wagner
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D036101:Cord Blood Stem Cell Transplantation / Q000379:methods* / Q000401:mortality; D003520:Cyclophosphamide / Q000627:therapeutic use; D016572:Cyclosporine / Q000627:therapeutic use; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods*; D008224:Lymphoma, Follicular / Q000628:therapy; D016403:Lymphoma, Large B-Cell, Diffuse / Q000628:therapy; D008228:Lymphoma, Non-Hodgkin / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D016019:Survival Analysis; D019172:Transplantation Conditioning / Q000379:methods*; D014740:Vidarabine / Q000031:analogs & derivatives / Q000627:therapeutic use; D014916:Whole-Body Irradiation; D055815:Young Adult
chemical_list: D016572:Cyclosporine; D003520:Cyclophosphamide; D014740:Vidarabine; D009173:Mycophenolic Acid; C024352:fludarabine