Reduced intensity allogeneic hematopoietic stem cell transplantation for MDS using tacrolimus/sirolimus-based GVHD prophylaxis.
We report a consecutive series of 59 patients with MDS who underwent reduced-intensity hematopoietic stem cell transplantation (RI-HSCT) with fludarabine/melphalan conditioning and tacrolimus/sirolimus-based GVHD prophylaxis. Two-year OS, EFS, and relapse incidences were 75.1%, 65.2%, and 20.9%, respectively. The cumulative incidence of non-relapse mortality at 100 days, 1 year, and 2 years was 3.4%, 8.5%, and 10.5%, respectively. The incidence of grade II-IV acute GVHD was 35.4%; grade III-IV was 18.6%. Forty of 55 evaluable patients developed chronic GVHD; of these 35 were extensive grade. This RI-HSCT protocol produces encouraging outcomes in MDS patients, and tacrolimus/sirolimus-based GVHD prophylaxis may contribute to that promising result.
Department of Hematology/Hematopoietic Cell Transplantation, City of Hope, Duarte, CA 91010, USA. rnakamura@coh.org
Ryotaro
R
Nakamura
Joycelynne M
JM
Palmer
Margaret R
MR
O'Donnell
Tracey
T
Stiller
Sandra H
SH
Thomas
Joseph
J
Chao
Joseph
J
Alvarnas
Pablo M
PM
Parker
Vinod
V
Pullarkat
Rodrigo
R
Maegawa
Anthony S
AS
Stein
David S
DS
Snyder
Ravi
R
Bhatia
Karen
K
Chang
Shirong
S
Wang
Ji-Lian
JL
Cai
David
D
Senitzer
Stephen J
SJ
Forman
D000328:Adult; D000368:Aged; D018890:Chemoprevention / Q000379:methods; D004305:Dose-Response Relationship, Drug; D004338:Drug Combinations; D005260:Female; D006086:Graft vs Host Disease / Q000453:epidemiology / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D015994:Incidence; D008297:Male; D008558:Melphalan / Q000008:administration & dosage / Q000009:adverse effects; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D020123:Sirolimus / Q000008:administration & dosage*; D016019:Survival Analysis; D016559:Tacrolimus / Q000008:administration & dosage*; D019172:Transplantation Conditioning / Q000379:methods*; D014184:Transplantation, Homologous; D014740:Vidarabine / Q000008:administration & dosage / Q000031:analogs & derivatives; D055815:Young Adult
D004338:Drug Combinations; D007166:Immunosuppressive Agents; D014740:Vidarabine; C024352:fludarabine; D008558:Melphalan; D020123:Sirolimus; D016559:Tacrolimus