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- Title
Reduced-intensity conditioning using fludarabine, melphalan and thiotepa for adult patients undergoing haploidentical SCT.
- Authors
Ciurea, S. O.; Saliba, R.; Rondon, G.; Pesoa, S.; Cano, P.; Fernandez-Vina, M.; Qureshi, S.; Worth, L. L.; McMannis, J.; Kebriaei, P.; Jones, R. B.; Korbling, M.; Qazilbash, M.; Shpall, E. J.; Giralt, S.; Lima, M. de; Champlin, R. E.; Gajewski, J.
- Abstract
Haploidentical SCT (HaploSCT) has been most commonly performed using a myeloablative, TBI-based preparative regimen; however, the toxicity with this approach remains very high. We studied the feasibility of a reduced-intensity conditioning regimen in a phase II clinical trial using fludarabine, melphalan and thiotepa and antithymocyte globulin (ATG) for patients with advanced hematological malignancies undergoing T-cell depleted HaploSCT. Twenty-eight patients were entered in the study. Engraftment with donor-derived hematopoiesis was achieved in 78% of patients after a median of 13 days. Six patients experienced primary graft failure, three out of four tested patients had donor-specific anti-HLA antibodies (DSA) (P=0.001). Toxicity included mostly infections. A total of 21 out of 22 patients with AML/myelodysplastic syndrome (MDS) achieved remission after transplant (16 with relapsed/refractory AML). Five out of the 12 patients (42%) with AML/MDS with <15% BM blasts survived long term as compared with none with more advanced disease (P=0.03). HaploSCT with this fludarabine, melphalan and thiotepa and ATG RIC is an effective, well-tolerated conditioning regimen for patients with AML/MDS with low disease burden at the time of transplant and allowed a high rate of engraftment in patients without DSA. Patients with overt relapse fared poorly and require novel treatment strategies.
- Subjects
HEMATOPOIETIC stem cell transplantation; MEDICAL research; FLUDARABINE; THIOTEPA; ORGANOTHIOPHOSPHORUS compounds; CLINICAL trials; GLOBULINS; MYELODYSPLASTIC syndromes
- Publication
Bone Marrow Transplantation, 2010, Vol 45, Issue 3, p429
- ISSN
0268-3369
- Publication type
Article
- DOI
10.1038/bmt.2009.189