title: Clinical effect of reduced-intensity conditioning regimen containing antithymocyte globulin for hematopoietic cell transplantation from unrelated-donors.
abstract: The impact of reduced-intensity conditioning (RIC) on the outcomes of hematopoietic cell transplantation (HCT) from unrelated -donors (UD) remains to be determined. We therefore assessed 128 patients, aged 16 to 66 years, with acute leukemia (n = 105) or myelodysplastic syndrome (n = 23) in a UD-HCT trial using RIC with busulfan, fludarabine, and antithymocyte globulin. Patients were transplanted with unmanipulated bone marrow (BM, n = 41) or mobilized peripheral blood mononuclear cells (M-PB, n = 87) and received cyclosporine and methotrexate for graft-versus-host disease (GVHD) prophylaxis. After a median follow-up of 26.7 months (range, 5.9-70.7 months) in surviving patients, 19 patients had died without progression/recurrence of underlying disease, giving a cumulative incidence of transplantation-related mortality (TRM) of 17% (95% confidence interval, 11%-27%; 1-year TRM, 14%). Graft failure (n = 7) and infections (n = 5) were the most common causes of TRM. Only three patients died due to GVHD (acute, one; chronic, two). Graft failure, which occurred in eight patients, showed a significant correlation with graft source (BM, 6/41 vs. M-PB, 2/87; P = 0.009). Donor-patient HLA-disparity did not correlate with GVHD, 1-year TRM, and graft failure. RIC containing antithymocyte globulin led to decreased GVHD-associated, as well as overall, TRM after UD-HCT.
authors.affiliation: Department of Internal Medicine, Hematology Section, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea. khlee2@amc.seoul.kr
authors.forename: Kyoo-Hyung
authors.initials: KH
authors.lastname: Lee
authors.forename: Seong-Jun
authors.initials: SJ
authors.lastname: Choi
authors.forename: Je-Hwan
authors.initials: JH
authors.lastname: Lee
authors.forename: Jung-Hee
authors.initials: JH
authors.lastname: Lee
authors.forename: Dae-Young
authors.initials: DY
authors.lastname: Kim
authors.forename: Miee
authors.initials: M
authors.lastname: Seol
authors.forename: Young-Shin
authors.initials: YS
authors.lastname: Lee
authors.forename: Young-Ah
authors.initials: YA
authors.lastname: Kang
authors.forename: Mijin
authors.initials: M
authors.lastname: Jeon
authors.forename: Sung-Cheol
authors.initials: SC
authors.lastname: Yun
authors.forename: Young-Don
authors.initials: YD
authors.lastname: Joo
authors.forename: Won-Sik
authors.initials: WS
authors.lastname: Lee
authors.forename: Myoung-Joo
authors.initials: MJ
authors.lastname: Kang
authors.forename: Hawk
authors.initials: H
authors.lastname: Kim
authors.forename: Jae-Hoo
authors.initials: JH
authors.lastname: Park
authors.forename: Sung-Hwa
authors.initials: SH
authors.lastname: Bae
authors.forename: Hun-Mo
authors.initials: HM
authors.lastname: Ryoo
authors.forename: Min-Kyoung
authors.initials: MK
authors.lastname: Kim
authors.forename: Myung-Soo
authors.initials: MS
authors.lastname: Hyun
mesh_terms: D000293:Adolescent; D000328:Adult; D000961:Antilymphocyte Serum / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D016026:Bone Marrow Transplantation / Q000009:adverse effects / Q000401:mortality; D002066:Busulfan / Q000008:administration & dosage / Q000627:therapeutic use; D006085:Graft Survival / Q000187:drug effects; D006086:Graft vs Host Disease / Q000517:prevention & control; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000401:mortality*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D015470:Leukemia, Myeloid, Acute / Q000628:therapy; D008499:Medical Records; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000628:therapy; D036102:Peripheral Blood Stem Cell Transplantation / Q000009:adverse effects / Q000401:mortality; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000628:therapy; D012189:Retrospective Studies; D016019:Survival Analysis; D019172:Transplantation Conditioning / Q000379:methods*; D014740:Vidarabine / Q000031:analogs & derivatives / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000961:Antilymphocyte Serum; D000970:Antineoplastic Agents; D007166:Immunosuppressive Agents; D014740:Vidarabine; D002066:Busulfan; C024352:fludarabine