Salvage allogeneic hematopoietic cell transplantation with fludarabine and low-dose total body irradiation after rejection of first allografts.
We summarized results in 38 consecutive patients (median age=56 years) with hematologic malignancies (n=35), aplastic anemia (n=2), or renal cell carcinoma (n=1), who underwent salvage hematopoietic cell transplantation (HCT) for allograft rejection. In 14 patients, the original donors were used for salvage HCT, and, in 24 cases, different donors were used. Conditioning for salvage HCT consisted of fludarabine (Flu) and either 3 or 4 Gy total body irradiation (TBI). Sustained engraftment was achieved in 33 patients (87%). Grafts were rejected in 5 patients (13%), 4 of whom had myelofibrosis. With a median follow-up of 2 years (range: 0.3 to 7.8 years), the 2- and 4-year estimated survivals were 49% and 42%, respectively. The 2-year relapse rate and nonrelapse mortality (NRM) were 36% and 24%, respectively. The 2-year cumulative incidences of grades II-IV acute and moderate-severe chronic graft-versus-host disease (aGVHD, cGVHD) were 42% and 41%, respectively. In this cohort, TBI dose, grafts from original versus different donors, related versus unrelated donors, and HCT comorbidity scores did not have an impact on outcomes. We concluded that graft rejection after allogeneic HCT could be overcome by salvage transplantation using conditioning with Flu and low-dose TBI.
Gyurkocza
Boglarka
B
Fred Hutchinson Cancer Research Center and the University of Washington School of Medicine, Seattle, Washington 98109-1024, USA.
Cao
Thai M
TM
Storb
Rainer F
RF
Lange
Thoralf
T
Leisenring
Wendy
W
Franke
Georg N
GN
Sorror
Mohamed
M
Hoppe
Richard
R
Maloney
David G
DG
Negrin
Robert S
RS
Shizuru
Judith A
JA
Sandmaier
Brenda M
BM
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000741:Anemia, Aplastic / Q000401:mortality / Q000628:therapy; D002648:Child; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000401:mortality* / Q000628:therapy*; D006086:Graft vs Host Disease; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D019653:Myeloablative Agonists / Q000008:administration & dosage*; D009369:Neoplasms / Q000401:mortality / Q000628:therapy; D012008:Recurrence; D012189:Retrospective Studies; D016879:Salvage Therapy; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous; D014740:Vidarabine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D014916:Whole-Body Irradiation
D019653:Myeloablative Agonists; D014740:Vidarabine; C024352:fludarabine