title: Bone marrow graft as a source of allogeneic hematopoietic stem cells in patients undergoing a reduced intensity conditioning regimen.
abstract: In an attempt to reduce the incidence of chronic GVHD (cGVHD) after reduced-intensity conditioning (RIC), we used BM instead of PBSC and added melphalan 100 mg/m(2) to the classical association of fludarabine, 30 mg/m(2)/day for 3 days and TBI, 200 cGy (FLUIM regimen). Between 2000 and 2012, 51 patients received BM with the FLUIM regimen (group A), and 124 received BM (n=22) or PBSC (n=102) with another RIC regimen (group B). Donors were siblings (n=123) or HLA-matched 10/10 unrelated (n=52). Full donor-type chimerism at day 100 was more often recorded in group A (86%) than in group B (62%); P<0.001. There was no difference between the two groups in terms of OS and EFS, acute GVHD, relapse and non-relapse mortality incidence. cGVHD occurred more often in group B (41%) than in group A (23%); P=0.021. In multivariate analysis, the two risk factors associated with the development of cGVHD were conditioning in group B (hazard ratio (HR)=2.871, 95% confidence interval (CI) (1.372-6.006); P=0.005) and CD34(+) count (HR=1.009, 95% CI (1.006-1.011); P<0.001). In conclusion, the FLUIM regimen followed by BM leads to more frequent full-donor chimerism and a reduced incidence of cGVHD without compromising relapse and survival.
authors.affiliation: Unité de Greffe de Cellules Souches Hématopoïétiques, Service des Maladies du Sang, CHRU Lille, Lille, France.
authors.forename: E
authors.initials: E
authors.lastname: Gomez
authors.affiliation: Unité de Greffe de Cellules Souches Hématopoïétiques, Service des Maladies du Sang, CHRU Lille, Lille, France.
authors.forename: R
authors.initials: R
authors.lastname: Duléry
authors.affiliation: Centre d'Etude et de Recherche en Informatique Médicale, Faculté de Médecine Lille 2, Lille, France.
authors.forename: C
authors.initials: C
authors.lastname: Langlois
authors.affiliation: Unité de Greffe de Cellules Souches Hématopoïétiques, Service des Maladies du Sang, CHRU Lille, Lille, France.
authors.forename: V
authors.initials: V
authors.lastname: Coiteux
authors.affiliation: Unité de Greffe de Cellules Souches Hématopoïétiques, Service des Maladies du Sang, CHRU Lille, Lille, France.
authors.forename: L
authors.initials: L
authors.lastname: Terriou
authors.affiliation: Unité de Greffe de Cellules Souches Hématopoïétiques, Service des Maladies du Sang, CHRU Lille, Lille, France.
authors.forename: L
authors.initials: L
authors.lastname: Magro
authors.affiliation: Unité de Greffe de Cellules Souches Hématopoïétiques, Service des Maladies du Sang, CHRU Lille, Lille, France.
authors.forename: J
authors.initials: J
authors.lastname: Gauthier
authors.affiliation: Unité de Greffe de Cellules Souches Hématopoïétiques, Service des Maladies du Sang, CHRU Lille, Lille, France.
authors.forename: E
authors.initials: E
authors.lastname: de Berranger
authors.affiliation: Centre d'Etude et de Recherche en Informatique Médicale, Faculté de Médecine Lille 2, Lille, France.
authors.forename: A
authors.initials: A
authors.lastname: Duhamel
authors.affiliation: Unité de Greffe de Cellules Souches Hématopoïétiques, Service des Maladies du Sang, CHRU Lille, Lille, France.
authors.forename: I
authors.initials: I
authors.lastname: Yakoub-Agha
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001853:Bone Marrow / Q000276:immunology*; D016026:Bone Marrow Transplantation; D005260:Female; D006086:Graft vs Host Disease; D019337:Hematologic Neoplasms / Q000276:immunology* / Q000628:therapy*; D006801:Humans; D008297:Male; D008558:Melphalan / Q000008:administration & dosage; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D033581:Stem Cell Transplantation; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014740:Vidarabine / Q000008:administration & dosage / Q000031:analogs & derivatives; D055815:Young Adult
chemical_list: D014740:Vidarabine; C024352:fludarabine; D008558:Melphalan