title: Salvage allogeneic hematopoietic cell transplantation with fludarabine and low-dose total body irradiation after rejection of first allografts.
abstract: 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.
authors.affiliation: Fred Hutchinson Cancer Research Center and the University of Washington School of Medicine, Seattle, Washington 98109-1024, USA.
authors.forename: Boglarka
authors.initials: B
authors.lastname: Gyurkocza
authors.forename: Thai M
authors.initials: TM
authors.lastname: Cao
authors.forename: Rainer F
authors.initials: RF
authors.lastname: Storb
authors.forename: Thoralf
authors.initials: T
authors.lastname: Lange
authors.forename: Wendy
authors.initials: W
authors.lastname: Leisenring
authors.forename: Georg N
authors.initials: GN
authors.lastname: Franke
authors.forename: Mohamed
authors.initials: M
authors.lastname: Sorror
authors.forename: Richard
authors.initials: R
authors.lastname: Hoppe
authors.forename: David G
authors.initials: DG
authors.lastname: Maloney
authors.forename: Robert S
authors.initials: RS
authors.lastname: Negrin
authors.forename: Judith A
authors.initials: JA
authors.lastname: Shizuru
authors.forename: Brenda M
authors.initials: BM
authors.lastname: Sandmaier
mesh_terms: 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
chemical_list: D019653:Myeloablative Agonists; D014740:Vidarabine; C024352:fludarabine