title: Unmanipulated haploidentical bone marrow transplantation and posttransplantation cyclophosphamide for hematologic malignancies after myeloablative conditioning.
abstract: Fifty patients with high-risk hematologic malignancies, underwent an unmanipulated haploidentical bone marrow transplantation (BMT), followed by posttransplantation high-dose cyclophosphamide (PT-CY): the myeloablative (MA) conditioning consisted of thiotepa, busulfan, fludarabine (n = 35), or total body irradiation (TBI), fludarabine (n = 15). The median age was 42 years (range, 18-66 years); 23 patients were in remission, 27 had active disease, and 10 patients were receiving a second allograft. Graft-versus-host disease (GVHD) prophylaxis consisted in PT-CY on day +3 and +5, cyclosporine (from day 0), and mycophenolate (from day +1). Three patients died before engraftment, and 2 patients had autologous recovery: 45 patients (90%) had full-donor chimerism on day +30. The median day for neutrophil engraftment was day +18 (range, 13-30 days). The cumulative incidence of grade II-III acute GVHD (aGVHD) was 12%, and of moderate chronic GVHD (cGVHD) 10%. With a median follow-up for surviving patients of 333 days (range, 149-623 days), the cumulative incidence of transplantation-related mortality (TRM) was 18%, and the rate of relapse was 26%. The actuarial 22-month disease-free survival (DFS) rate was 68% for patients in remission and 37% for patients with active disease (P < .001). Causes of death were pneumonia (n = 3), hemorrhage (n = 3), sepsis (n = 3), and relapse (n = 7). In conclusion, an MA conditioning regimen followed by haploidentical BMT with PT-CY results in a low risk of aGVHD and cGVHD and encouraging rates of TRM and DFS.
authors.affiliation: Divisione Ematologia e Trapianto di Midollo, IRCCS San Martino, Genova, Italy.
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Raiola
authors.forename: Alida
authors.initials: A
authors.lastname: Dominietto
authors.forename: Anna
authors.initials: A
authors.lastname: Ghiso
authors.forename: Carmen
authors.initials: C
authors.lastname: Di Grazia
authors.forename: Teresa
authors.initials: T
authors.lastname: Lamparelli
authors.forename: Francesca
authors.initials: F
authors.lastname: Gualandi
authors.forename: Stefania
authors.initials: S
authors.lastname: Bregante
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Van Lint
authors.forename: Simona
authors.initials: S
authors.lastname: Geroldi
authors.forename: Silvia
authors.initials: S
authors.lastname: Luchetti
authors.forename: Filippo
authors.initials: F
authors.lastname: Ballerini
authors.forename: Maurizio
authors.initials: M
authors.lastname: Miglino
authors.forename: Riccardo
authors.initials: R
authors.lastname: Varaldo
authors.forename: Andrea
authors.initials: A
authors.lastname: Bacigalupo
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects; D016026:Bone Marrow Transplantation; D002066:Busulfan / Q000008:administration & dosage / Q000009:adverse effects; D002908:Chronic Disease; D003520:Cyclophosphamide / Q000008:administration & dosage* / Q000009:adverse effects; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000209:etiology / Q000401:mortality / Q000517:prevention & control; D019337:Hematologic Neoplasms / Q000401:mortality / Q000628:therapy; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D019653:Myeloablative Agonists / Q000008:administration & dosage / Q000009:adverse effects; D012189:Retrospective Studies; D015996:Survival Rate; D013852:Thiotepa / Q000008:administration & dosage / Q000009:adverse effects; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous; D014740:Vidarabine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives; D014916:Whole-Body Irradiation
chemical_list: D000970:Antineoplastic Agents; D007166:Immunosuppressive Agents; D019653:Myeloablative Agonists; D003520:Cyclophosphamide; D013852:Thiotepa; D014740:Vidarabine; D002066:Busulfan; C024352:fludarabine