Abstract
Nonmyeloablative stem cell transplantation (NST) harnesses the graft-versus-tumor effect while minimizing regimen-related toxicity, and can result in donor chimerism and remission. Acute graft-versus-host disease (GVHD) and infections are major complications after sibling NST. Toxicity of unrelated-donor (UD) NST and the most appropriate GVHD prophylaxis in this setting remain poorly defined. We describe 25 patients who received UD-NST conditioned with fludarabine and cyclophosphamide. The first six patients received cyclosporine (Cs) and mycophenolate mofetil (MMF) (n = 5) or methotrexate (MTX) (n = 1) as GVHD prophylaxis (group 1) and all developed grade IH-IV acute GVHD. The next 19 patients received the same conditioning regimen with the addition of alemtuzumab, and all received Cs/MTX post-transplant. Engraftment and donor chimerism were achieved in all but one evaluable patient. In all, 15 patients died: five of six deaths in group 1 were attributable to acute GVHD, while deaths in group 2 were due to infection or progressive disease (P = 0.05). The combination of Cs/MMF is inadequate GVHD prophylaxis for UD-NST. The use of Cs, MTX, and alemtuzumab eliminated severe acute GVHD; its impact on response merits further study.
Original language | English (US) |
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Pages (from-to) | 921-926 |
Number of pages | 6 |
Journal | Bone marrow transplantation |
Volume | 35 |
Issue number | 9 |
DOIs | |
State | Published - May 2005 |
Externally published | Yes |
Keywords
- Adoptive
- Graft-versus-host disease
- Hematopoietic stem cell transplantation
- Immunotherapy
- Nonmyeloablative conditioning
ASJC Scopus subject areas
- Hematology
- Transplantation