title: Fludarabine, melphalan, thiotepa and anti-thymocyte globulin conditioning for unrelated cord blood transplant.
abstract: Unrelated cord blood transplant (CBT) is an alternative treatment option for patients who lack a matched donor. However, the optimal type and intensity of the preparative regimen remains unclear. We evaluated the toxicity and outcomes of a conditioning regimen consisting of melphalan 140 mg/m(2) (day - 8), thiotepa 10 mg/kg (day - 7), fludarabine 160 mg/m(2) over 4 days (days - 6 to - 3) and rabbit antithymocyte globulin (ATG) 1.25 mg/kg (day - 4) and 1.75 mg/kg (day - 3) (FMT). Forty-seven patients with advanced hematologic malignancies with a median age of 23 years (30 adults and 17 children) were treated. Sixty percent of patients were in remission at transplant. Ninety-one percent of the patients engrafted neutrophils after a median of 22 days, and all but one of the patients achieving donor engraftment had hematopoietic recovery with 100% cord blood-derived cells. Grade 3 gastrointestinal toxicity was the major non-hematopoietic toxicity, occurring in 32% of patients. Cumulative incidence of day-100 grade II-IV acute graft-versus-host disease (aGVHD) and chronic graft-versus-host disease (cGVHD) was 53% and 34%, respectively, and non-relapse mortality at day 100 and 2 years was 11% and 40%. Two-year disease-free and overall survival rates were 31% and 44%, respectively. These results suggest that FMT is a feasible conditioning regimen for patients undergoing CBT.
authors: Department of Stem Cell Transplant and Cellular Therapy, Hospital Israelita Albert Einstein, Sao Paulo, Brazil.
authors: Stefan O
authors: SO
authors: Ciurea
authors: Rima M
authors: RM
authors: Saliba
authors: Nelson
authors: N
authors: Hamerschlak
authors: Amado J
authors: AJ
authors: Karduss Aurueta
authors: Roland
authors: R
authors: Bassett
authors: Marcelo
authors: M
authors: Fernandez-Vina
authors: Demetrios
authors: D
authors: Petropoulos
authors: Laura L
authors: LL
authors: Worth
authors: Ka Wah
authors: KW
authors: Chan
authors: Daniel R
authors: DR
authors: Couriel
authors: Gabriela
authors: G
authors: Rondon
authors: Manish
authors: M
authors: Sharma
authors: Muzaffar
authors: M
authors: Qazilbash
authors: Roy B
authors: RB
authors: Jones
authors: Partow
authors: P
authors: Kebriaei
authors: John
authors: J
authors: McMannis
authors: Chitra M
authors: CM
authors: Hosing
authors: Yago
authors: Y
authors: Nieto
authors: Richard E
authors: RE
authors: Champlin
authors: Elizabeth J
authors: EJ
authors: Shpall
authors: Marcos
authors: M
authors: de Lima
mesh_terms: D000293:Adolescent; D000328:Adult; D000961:Antilymphocyte Serum / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D036101:Cord Blood Stem Cell Transplantation / Q000379:methods*; D005240:Feasibility Studies; D006085:Graft Survival; D006086:Graft vs Host Disease; D019337:Hematologic Neoplasms / Q000628:therapy*; D006801:Humans; D008558:Melphalan / Q000008:administration & dosage; D015996:Survival Rate; D013852:Thiotepa / Q000008:administration & dosage; D019172:Transplantation Conditioning / Q000379:methods*; D014740:Vidarabine / Q000008:administration & dosage / Q000031:analogs & derivatives; D055815:Young Adult
chemical_list: D000961:Antilymphocyte Serum; D013852:Thiotepa; D014740:Vidarabine; C024352:fludarabine; D008558:Melphalan