title: Reduced-intensity conditioning allogeneic hematopoietic cell transplantation for patients with hematologic malignancies who relapse following autologous transplantation: a multi-institutional prospective study from the Cancer and Leukemia Group B (CALGB trial 100002).
abstract: We prospectively treated 80 patients with relapse of malignancy or secondary myelodysplasia after autologous hematopoietic cell transplantation (AHCT) with allogeneic HCT (allo-HCT) using a reduced-intensity conditioning regimen of fludarabine 150 mg/m(2) plus intravenous busulfan 6.4 mg/kg. Both matched sibling (MSD) and unrelated donors (MUD) were allowed. Patients transplanted from MUD donors received more intensive graft-versus-host disease (GVHD) prophylaxis, including rabbit antithymocyte globulin (ATG) 10 mg/kg, mycophenolate mofetil, and an extended schedule of tacrolimus. With a median follow-up of 3.1 years (0.9-5.8), treatment-related mortality (TRM) at 6 months and 2 years was 8% and 23%, respectively. Neither TRM nor the rates of acute GVHD (aGVHD) were different in those with sibling or MUD donors. Donor CD3 cell chimerism >90% at day +30 was achieved more often in patients with MUD than with matched sibling donors, 70% versus 23% (P < .0001). Median event-free suvival was higher in patients who achieved early full donor chimerism (14.2 versus 8 months, P = .0395). Allo-HCT using this reduced-intensity conditioning regimen can be performed with low TRM in patients who have received a prior AHCT. Efforts to improve early donor CD3 chimerism may improve event-free survival.
authors.affiliation: University of California at San Diego, San Diego, CA, USA. abashey@bmtga.com
authors.forename: Asad
authors.initials: A
authors.lastname: Bashey
authors.forename: Kouros
authors.initials: K
authors.lastname: Owzar
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Johnson
authors.forename: Peggy S
authors.initials: PS
authors.lastname: Edwards
authors.forename: Michael
authors.initials: M
authors.lastname: Kelly
authors.forename: Lee-Ann
authors.initials: LA
authors.lastname: Baxter-Lowe
authors.forename: Steven
authors.initials: S
authors.lastname: Devine
authors.forename: Sherif
authors.initials: S
authors.lastname: Farag
authors.forename: David
authors.initials: D
authors.lastname: Hurd
authors.forename: Edward
authors.initials: E
authors.lastname: Ball
authors.forename: Philip
authors.initials: P
authors.lastname: McCarthy
authors.forename: John
authors.initials: J
authors.lastname: Lister
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Shea
authors.forename: Charles
authors.initials: C
authors.lastname: Linker
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000401:mortality / Q000517:prevention & control; D019337:Hematologic Neoplasms / Q000401:mortality / Q000517:prevention & control*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011817:Rabbits; D012008:Recurrence; D015996:Survival Rate; D019172:Transplantation Conditioning / Q000379:methods*; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous