Abstract
In an attempt to decrease toxicity in high-risk patients undergoing unrelated donor hematopoietic stem cell transplantation (URD HSCT), we tested a combination of cyclosporine (CSP) and mycophenolate mofetil (MMF) as graft-versus-host disease (GVHD) prophylaxis with the reduced-intensity conditioning regimen fludarabine/melphalan (Flu/Mel). A total of 22 adult patients with advanced myeloid (n = 15) and lymphoid (n = 7) malignancies were treated. All patients received Flu 25 mg/m2 for 5 days and Mel 140 mg/m2, with CSP 3 mg/kg daily and MMF 15 mg/kg three times a day. The median age was 49 years (range 18-66). Durable engraftment was seen in all but one patient with myelofibrosis. The 1-year nonrelapse mortality was 32%, 27% from GVHD. The cumulative incidence of acute GVHD grade 2-4 and 3-4 was 63 and 41%, respectively. With a median follow-up of 18 months, the disease-free survival (DFS) and overall survival (OS) are 55 and 59%, respectively. For patients with AML and MDS (n = 14), the DFS and OS is 71%. For patients undergoing a second transplant (n = 14), the DFS and OS is 57%. In conclusion, this regimen is associated with acceptable toxicity but high rates of GVHD in high-risk patients undergoing URD HSCT. Encouraging disease control for patients with advanced myeloid malignancies was observed.
Original language | English (US) |
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Pages (from-to) | 1123-1129 |
Number of pages | 7 |
Journal | Bone marrow transplantation |
Volume | 33 |
Issue number | 11 |
DOIs | |
State | Published - Jun 1 2004 |
Externally published | Yes |
Keywords
- Adult
- Graft-versus-host disease
- Hematopoietic cell transplantation
- Reduced-intensity conditioning
- Unrelated donor
ASJC Scopus subject areas
- Hematology
- Transplantation