Non-myeloablative conditioning for lower-risk myelodysplastic syndrome with bone marrow blasts less than 5 %-a feasibility study.
Reduced-intensity conditioning (RIC) regimens can cause decreased non-relapse mortality (NRM) but lead to higher relapse rates in higher-risk myelodysplastic syndrome (MDS). However, relapse is not the main problem after hematopoietic cell transplantation (HCT) in lower-risk MDS, and post-transplant outcomes may therefore improve with less intense non-myeloablative conditioning (NMC) regimens. We here report the results of a single-center feasibility study of NMC with cyclophosphamide-fludarabine-antithymocyte globulin (CyFluATG) in MDS patients with bone marrow blasts <5 %. We compared post-transplant outcomes between CyFluATG and a RIC regimen, busulfan-fludarabine-antithymocyte globulin (BuFluATG). Fifteen MDS patients received allogeneic HCT after CyFluATG conditioning comprising cyclophosphamide (100 mg/kg), fludarabine (150 mg/m(2)), and ATG, and 30 MDS historical control patients received BuFluATG conditioning which contained busulfan (8 [oral] or 6.4 [i.v.] mg/kg), fludarabine, and ATG. The 4-year overall survival (OS) and NRM rates were 80.0 and 20.0 % for CyFluATG and 73.3 and 20.0 % for BuFluATG, respectively. Neutrophil and platelet engraftment was significantly faster with CyFluATG than BuFluATG (median 12 vs. 14 days, P = 0.005 for neutrophils; median 15 vs. 21 days, P = 0.032 for platelets). CyFluATG produced a faster immune reconstitution of T-cells at 1 month after HCT than BuFluATG. Fertility was maintained after HCT with CyFluATG. In conclusion, the CyFluATG regimen is feasible in lower-risk MDS patients in terms of adequate engraftment and low NRM.
Department of Hematology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Eun-Ji
EJ
Choi
Department of Hematology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea. jhlee3@amc.seoul.kr.
Je-Hwan
JH
Lee
Department of Hematology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Jung-Hee
JH
Lee
Department of Hematology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Dae-Young
DY
Kim
Department of Hematology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Han-Seung
HS
Park
Department of Hematology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Miee
M
Seol
Department of Hematology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Young-Shin
YS
Lee
Department of Hematology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Young-Ah
YA
Kang
Department of Hematology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Mijin
M
Jeon
Department of Hematology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Kyoo-Hyung
KH
Lee
D000293:Adolescent; D000328:Adult; D000961:Antilymphocyte Serum / Q000008:administration & dosage; D001854:Bone Marrow Cells / Q000187:drug effects / Q000473:pathology*; D002066:Busulfan / Q000008:administration & dosage; D003520:Cyclophosphamide / Q000008:administration & dosage; D005240:Feasibility Studies; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000175:diagnosis* / Q000628:therapy*; D019172:Transplantation Conditioning / Q000379:methods*; D014184:Transplantation, Homologous / Q000379:methods; D014740:Vidarabine / Q000008:administration & dosage / Q000031:analogs & derivatives; D055815:Young Adult
D000961:Antilymphocyte Serum; D003520:Cyclophosphamide; D014740:Vidarabine; D002066:Busulfan; C024352:fludarabine
Cyclophosphamide; Hematopoietic cell transplantation; Lower-risk; Myelodysplastic syndrome; Non-myeloablative conditioning