title: Long-term disease-free survival after nonmyeloablative cyclophosphamide/fludarabine conditioning and related/unrelated allotransplantation for acute myeloid leukemia/myelodysplasia.
abstract: A total of 50 consecutive patients (median age, 57.5 years) with AML (n=30) or myelodysplasia (MDS, n=20) underwent HLA matched related donor (MRD, n=27) or unrelated donor (MUD, n=23) peripheral blood hematopoietic cell transplantation after nonmyeloablative CY/fludarabine (Flu) conditioning. GVHD prophylaxis included CsA (n=19)+/-mycophenolate mofetil (n=31). At a median follow-up of 59 months, 21 patients (42%) were alive without evidence of disease. By Kaplan-Meier analysis, year 1-4 disease-free survival (DFS) and OS estimates were 0.50/0.58, 0.40/0.46, 0.37/0.43 and 0.37/0.41. MUD recipients were engrafted quickly (13.5 days) compared to MRD recipients (16 days) and relapsed/progressed less frequently (P=0.005). Overall grade 3/4 acute GVHD (aGVHD) occurred in 26% in the absence of antecedent mucositis and was associated with chronic GVHD (cGVHD) and poor OS. Extensive cGVHD developed in 51.2% of 100 day survivors. Rates of aGVHD, cGVHD and survival were similar between MRD and MUD recipients. Of 14 survivors with cGVHD, 5 (35.7%) experienced resolution off immunosuppression, suggesting that tolerance with HLA matched grafts is possible at an advanced age by this method. This study provides further evidence for prolonged DFS after CY/Flu MRD allotransplantation for AML/MDS, and extends the findings to older patients and those with unrelated donors.
authors.affiliation: Division of Hematology/Oncology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202-5289, USA. ronelson@iupui.edu
authors.forename: R P
authors.initials: RP
authors.lastname: Nelson
authors.forename: M
authors.initials: M
authors.lastname: Yu
authors.forename: J E
authors.initials: JE
authors.lastname: Schwartz
authors.forename: M J
authors.initials: MJ
authors.lastname: Robertson
authors.forename: R
authors.initials: R
authors.lastname: Hromas
authors.forename: C A
authors.initials: CA
authors.lastname: Fausel
authors.forename: G H
authors.initials: GH
authors.lastname: Vance
authors.forename: S R
authors.initials: SR
authors.lastname: Dlouhy
authors.forename: J A
authors.initials: JA
authors.lastname: Baute
authors.forename: E A
authors.initials: EA
authors.lastname: Cox
authors.forename: L L
authors.initials: LL
authors.lastname: Wood
authors.forename: S
authors.initials: S
authors.lastname: Srivastava
authors.forename: K A
authors.initials: KA
authors.lastname: Robertson
authors.forename: P R
authors.initials: PR
authors.lastname: Haut
authors.forename: S S
authors.initials: SS
authors.lastname: Farag
authors.forename: R
authors.initials: R
authors.lastname: Abonour
authors.forename: K
authors.initials: K
authors.lastname: Cornetta
authors.forename: L D
authors.initials: LD
authors.lastname: Cripe
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D003520:Cyclophosphamide / Q000627:therapeutic use; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000188:drug therapy / Q000517:prevention & control; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000628:therapy*; D016019:Survival Analysis; D019172:Transplantation Conditioning / Q000379:methods*; D014184:Transplantation, Homologous; D014740:Vidarabine / Q000031:analogs & derivatives / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D003520:Cyclophosphamide; D014740:Vidarabine; C024352:fludarabine