title: Multicenter experience using total lymphoid irradiation and antithymocyte globulin as conditioning for allografting in hematological malignancies.
abstract: A non myeloablative conditioning with total lymphoid irradiation (TLI) and antithymocyte globulin (ATG) was shown to protect against graft-versus-host disease (GVHD). To evaluate the effects of TLI-ATG in a multicenter study, 45 heavily pretreated patients, median age 51, with lymphoid (n = 38) and myeloid (n = 7) malignancies were enrolled at 9 centers. Twenty-eight patients (62%) received at least 3 lines of treatment before allografting, and 13 (29%) had refractory/relapsed disease at the time of transplantation. Peripheral blood hematopoietic cells were from HLA identical sibling (n = 30), HLA-matched (n = 9), or 1 antigen HLA-mismatched (n = 6) unrelated donors. A cumulative TLI dose of 8 Gy was administered from day -11 through -1 with ATG at the dose of 1.5 mg/kg/day (from day -11 through -7). GVHD prophylaxis consisted of cyclosporine and mycophenolate mofetil. Donor engraftment was reached in 95% of patients. Grade II to IV acute GVHD (aGVHD) developed in 6 patients (13.3%), and in 2 of these patients, it developed beyond day 100. Incidence of chronic GVHD (cGVHD) was 35.8%. One-year nonrelapse mortality was 9.1%. After a median follow-up of 28 months (range, 3-57 months) from transplantation, median overall survival was not reached, whereas median event-free survival was 20 months. This multicenter experience confirms that TLI-ATG protects against GVHD and maintains graft-vs-tumor effects.
authors.affiliation: Centro Unico Regionale Trapianti Alberto Neri, A.O. Bianchi-Melacrino-Morelli, Reggio Calabria, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Messina
authors.forename: Luisa
authors.initials: L
authors.lastname: Giaccone
authors.forename: Moreno
authors.initials: M
authors.lastname: Festuccia
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Irrera
authors.forename: Ilaria
authors.initials: I
authors.lastname: Scortechini
authors.forename: Roberto
authors.initials: R
authors.lastname: Sorasio
authors.forename: Federica
authors.initials: F
authors.lastname: Gigli
authors.forename: Roberto
authors.initials: R
authors.lastname: Passera
authors.forename: Irene
authors.initials: I
authors.lastname: Cavattoni
authors.forename: Andrea Riccardo
authors.initials: AR
authors.lastname: Filippi
authors.forename: Fabrizio Carnevale
authors.initials: FC
authors.lastname: Schianca
authors.forename: Massimo
authors.initials: M
authors.lastname: Pini
authors.forename: Antonio M
authors.initials: AM
authors.lastname: Risitano
authors.forename: Carmine
authors.initials: C
authors.lastname: Selleri
authors.forename: Alessandro
authors.initials: A
authors.lastname: Levis
authors.forename: Nicola
authors.initials: N
authors.lastname: Mordini
authors.forename: Andrea
authors.initials: A
authors.lastname: Gallamini
authors.forename: Rocco
authors.initials: R
authors.lastname: Pastano
authors.forename: Marco
authors.initials: M
authors.lastname: Casini
authors.forename: Massimo
authors.initials: M
authors.lastname: Aglietta
authors.forename: Mauro
authors.initials: M
authors.lastname: Montanari
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Console
authors.forename: Mario
authors.initials: M
authors.lastname: Boccadoro
authors.forename: Umberto
authors.initials: U
authors.lastname: Ricardi
authors.forename: Benedetto
authors.initials: B
authors.lastname: Bruno
mesh_terms: D000328:Adult; D000368:Aged; D000961:Antilymphocyte Serum / Q000494:pharmacology / Q000627:therapeutic use*; D016572:Cyclosporine / Q000494:pharmacology / Q000627:therapeutic use; D005260:Female; D006086:Graft vs Host Disease / Q000517:prevention & control*; D006680:HLA Antigens / Q000276:immunology; D019337:Hematologic Neoplasms / Q000276:immunology / Q000401:mortality / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation; D006648:Histocompatibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000494:pharmacology / Q000627:therapeutic use; D012008:Recurrence; D012720:Severity of Illness Index; D016019:Survival Analysis; D019172:Transplantation Conditioning / Q000379:methods*; D014184:Transplantation, Homologous; D014916:Whole-Body Irradiation
chemical_list: D000961:Antilymphocyte Serum; D006680:HLA Antigens; D016572:Cyclosporine; D009173:Mycophenolic Acid