Low-intensity conditioning is sufficient to ensure engraftment in matched unrelated bone marrow transplantation.

Abstract

OBJECTIVE:

Matched unrelated bone marrow transplantation (BMT) for patients with hematological malignancies is associated with a high incidence of transplant-related complications due to high doses of chemoradiotherapy administered pre-BMT to ensure engraftment. The aim of this study was to investigate the feasibility of low-intensity conditioning for BMT from matched unrelated donors.

MATERIALS AND METHODS:

Sixteen patients with hematologic malignancies underwent non-T-cell-depleted BMT following a low-intensity conditioning regimen consisting of fludarabine monophosphate 30 mg/m(2)/day for 6 days, busulfan 4 mg/kg/day for 2 days, anti-T lymphocyte globulin 10 mg/kg/day for 4 days. Seven of the patients suffered from chronic myelogenous leukemia, four from acute lymphoblastic leukemia, four from acute myelogenous leukemia, and one from Ki-1 non-Hodgkin's lymphoma. Three of the patients had secondary leukemia and two were post-autologous BMT (ABMT). All patients were transplanted from fully matched unrelated donors.

RESULTS:

Fifteen of the 16 patients had 100% donor chimerism; no graft rejection was observed. None of the patients developed >Grade II veno-occlusive disease, sepsis, multiorgan failure, or renal or pulmonary toxicity. Four patients died posttransplant; one of thrombocytopenia and severe hemorrhagic cystitis, one of central nervous system toxicity, one of Grade IV graft-vs-host disease, and one following relapse (9 months post-BMT). Survival and disease-free survival at 36 months are 75% (95% confidence interval 46-90%) and 60% (95% confidence interval 30-80%), respectively.

CONCLUSION:

These results indicate that low-intensity conditioning is sufficient to ensure stable engraftment of bone marrow grafts in a matched unrelated setting.

• Authors: A Nagler, M Aker, R Or, E Naparstek, G Varadi, C Brautbar, S Slavin
• Journal: Experimental hematology (Exp Hematol) Vol. 29 Issue 3 Pg. 362-70 (Mar 2001) ISSN: 0301-472X [Print] Netherlands
• PMID: 11274765 (Publication Type: Evaluation Study, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Antilymphocyte Serum
• Vidarabine
• Busulfan
• fludarabine

Topics

• Adolescent
• Adult
• Antilymphocyte Serum (administration & dosage)
• Bone Marrow Transplantation (adverse effects, methods, mortality)
• Busulfan (administration & dosage)
• Cell Count
• Child
• Cohort Studies
• Disease-Free Survival
• Female
• Graft Survival
• Histocompatibility
• Humans
• Leukemia (mortality, therapy)
• Life Tables
• Lymphoma, Large-Cell, Anaplastic (therapy)
• Male
• Middle Aged
• Recurrence
• Survival Analysis
• T-Lymphocytes
• Transplantation Conditioning (adverse effects, methods)
• Transplantation, Homologous (adverse effects, methods, mortality)
• Treatment Outcome
• Vidarabine (administration & dosage, analogs & derivatives)