Abstract |
Total body irradiation has been the mainstay of conditioning since the inception of allogeneic hematopoietic cell transplantation, but toxicity often precludes its use. For less-fit patients with acute lymphoblastic leukemia and other hematologic malignancies frequently affecting the central nervous system, we designed a radiation-free regimen with fludarabine (25 mg/m2/day on days -6 to -4), carmustine (400 mg/m2 on day -6), and thiotepa (5 mg/kg twice daily on days -5 and -4), all of which readily penetrate the blood-brain barrier and have potent antileukemic and lymphotoxic activity. Here we present a series of 30 consecutive patients with high-risk or relapsed disease who underwent allogeneic hematopoietic cell transplantation with this protocol. The median patient age was 60 years (range, 42-70 years), and the median follow-up was 968 days (range, 58-1989 days). Graft-versus-host disease prophylaxis consisted of cyclosporine A and alemtuzumab (10-20 mg). At 2 years, overall survival was 52% (95% confidence interval [CI], 34%-71%), event-free survival was 39% (95% CI, 22%-57%), cumulative incidence of relapse/progression was 30% (95% CI, 17%-52%), and treatment-related mortality was 31% (95% CI, 18%-53%). Neurologic toxicity is a concern, especially in older and heavily pretreated patients. Our experience indicates the feasibility of this regimen as an alternative to total body irradiation and a potentially curative option for less-fit patients who need a highly central nervous system-active conditioning.
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Authors | Petros Christopoulos, Hartmut Bertz, Gabriele Ihorst, Reinhard Marks, Ralph Wäsch, Jürgen Finke |
Journal | Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation
(Biol Blood Marrow Transplant)
Vol. 18
Issue 9
Pg. 1430-7
(Sep 2012)
ISSN: 1523-6536 [Electronic] United States |
PMID | 22430085
(Publication Type: Journal Article)
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Copyright | Copyright © 2012 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved. |
Chemical References |
- Antibodies, Monoclonal, Humanized
- Alemtuzumab
- Cyclosporine
- Thiotepa
- Vidarabine
- fludarabine
- Carmustine
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Topics |
- Adult
- Aged
- Alemtuzumab
- Antibodies, Monoclonal, Humanized
(therapeutic use)
- Carmustine
(therapeutic use)
- Central Nervous System
(drug effects, physiopathology)
- Cyclosporine
(therapeutic use)
- Drug Administration Schedule
- Female
- Follow-Up Studies
- Graft vs Host Disease
(immunology, mortality, prevention & control)
- Hematopoietic Stem Cell Transplantation
- Humans
- Leukemia, Myeloid, Acute
(immunology, mortality, therapy)
- Male
- Middle Aged
- Recurrence
- Survival Analysis
- Thiotepa
(therapeutic use)
- Transplantation Conditioning
(methods)
- Transplantation, Homologous
- Vidarabine
(analogs & derivatives, therapeutic use)
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