Intensive graft-versus-host disease prophylaxis is required after unrelated-donor nonmyeloablative stem cell transplantation

A. W. Loren, S. M. Luger, E. A. Stadtmauer, D. E. Tsai, S. Schuster, S. D. Nasta, S. C. Goldstein, A. Perl, Gregory Orloff, J. C. Oliver, J. Green, S. G. Emerson, D. L. Porter

Research output: Contribution to journalArticle

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 languageEnglish (US)
Pages (from-to)921-926
Number of pages6
JournalBone Marrow Transplantation
Volume35
Issue number9
DOIs
StatePublished - May 1 2005
Externally publishedYes

Fingerprint

Unrelated Donors
Stem Cell Transplantation
Graft vs Host Disease
Cyclosporine
Methotrexate
Mycophenolic Acid
Chimerism
Tissue Donors
Transplants
Infection
Cyclophosphamide
Siblings

Keywords

  • Adoptive
  • Graft-versus-host disease
  • Hematopoietic stem cell transplantation
  • Immunotherapy
  • Nonmyeloablative conditioning

ASJC Scopus subject areas

  • Hematology
  • Transplantation

Cite this

Loren, A. W., Luger, S. M., Stadtmauer, E. A., Tsai, D. E., Schuster, S., Nasta, S. D., ... Porter, D. L. (2005). Intensive graft-versus-host disease prophylaxis is required after unrelated-donor nonmyeloablative stem cell transplantation. Bone Marrow Transplantation, 35(9), 921-926. https://doi.org/10.1038/sj.bmt.1704887

Intensive graft-versus-host disease prophylaxis is required after unrelated-donor nonmyeloablative stem cell transplantation. / Loren, A. W.; Luger, S. M.; Stadtmauer, E. A.; Tsai, D. E.; Schuster, S.; Nasta, S. D.; Goldstein, S. C.; Perl, A.; Orloff, Gregory; Oliver, J. C.; Green, J.; Emerson, S. G.; Porter, D. L.

In: Bone Marrow Transplantation, Vol. 35, No. 9, 01.05.2005, p. 921-926.

Research output: Contribution to journalArticle

Loren, AW, Luger, SM, Stadtmauer, EA, Tsai, DE, Schuster, S, Nasta, SD, Goldstein, SC, Perl, A, Orloff, G, Oliver, JC, Green, J, Emerson, SG & Porter, DL 2005, 'Intensive graft-versus-host disease prophylaxis is required after unrelated-donor nonmyeloablative stem cell transplantation', Bone Marrow Transplantation, vol. 35, no. 9, pp. 921-926. https://doi.org/10.1038/sj.bmt.1704887
Loren, A. W. ; Luger, S. M. ; Stadtmauer, E. A. ; Tsai, D. E. ; Schuster, S. ; Nasta, S. D. ; Goldstein, S. C. ; Perl, A. ; Orloff, Gregory ; Oliver, J. C. ; Green, J. ; Emerson, S. G. ; Porter, D. L. / Intensive graft-versus-host disease prophylaxis is required after unrelated-donor nonmyeloablative stem cell transplantation. In: Bone Marrow Transplantation. 2005 ; Vol. 35, No. 9. pp. 921-926.
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AU - Tsai, D. E.

AU - Schuster, S.

AU - Nasta, S. D.

AU - Goldstein, S. C.

AU - Perl, A.

AU - Orloff, Gregory

AU - Oliver, J. C.

AU - Green, J.

AU - Emerson, S. G.

AU - Porter, D. L.

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