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High-dose melphalan and allogeneic peripheral blood stem cell transplantation for treatment of early relapse after allogeneic transplant.
Bone Marrow Transplant. 2000 Aug; 26(3):333-8.BM

Abstract

Patients with acute leukemias relapsing within 1 year of an allogeneic BMT have a poor prognosis. We studied the use of melphalan 180 mg/m2 followed by allogeneic peripheral blood stem cells (PBSC) as salvage treatment for patients relapsing after related (n = 7) or matched unrelated transplants (n = 3). Diagnoses were AML (n = 4), ALL (n = 3), biphenotypic acute leukemia (n = 2) and CML in blast crisis (n = 1). Eight patients were beyond first relapse and none were in remission. The median time from previous transplant to relapse was 146 days (range 66-206). The melphalan dose was 90 mg/m2 intravenously on days -4 and -3 with PBSC infusion on day 0. GVHD prophylaxis consisted of cyclosporine and methylprednisolone. The median time to an absolute neutrophil count >0.5 x 10(9)/l and to a platelet count >20 x 10(9)/l was 11 and 13 days, respectively. All engrafting patients (n = 8) had 100% donor cells. Two patients died before day 30, but no other grade 3 or 4 toxicity occurred. Acute GVHD grades II-III occurred in two subjects, and chronic GVHD in four. Seven patients achieved CR, but relapsed at a median of 116 days (range 56-614). Leukemia was the cause of death in eight patients. Median survival was 149 days (range 6-614). This treatment produced responses in the majority of this poor prognosis group. However, durable remissions were not observed, and new treatments to consolidate the responses achieved in this setting are needed. This regimen could be considered for short-term disease control to facilitate donor lymphocyte infusion-based immunotherapy or other measures to prevent disease recurrence.

Authors+Show Affiliations

Department of Blood and Marrow Transplantation, University of Texas MD Anderson Cancer Center, Houston 77030-4095, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article

Language

eng

PubMed ID

10967575

Citation

de Lima, M, et al. "High-dose Melphalan and Allogeneic Peripheral Blood Stem Cell Transplantation for Treatment of Early Relapse After Allogeneic Transplant." Bone Marrow Transplantation, vol. 26, no. 3, 2000, pp. 333-8.
de Lima M, van Besien K, Gajewski J, et al. High-dose melphalan and allogeneic peripheral blood stem cell transplantation for treatment of early relapse after allogeneic transplant. Bone Marrow Transplant. 2000;26(3):333-8.
de Lima, M., van Besien, K., Gajewski, J., Khouri, I., Andersson, B., Korbling, M., Champlin, R., & Giralt, S. (2000). High-dose melphalan and allogeneic peripheral blood stem cell transplantation for treatment of early relapse after allogeneic transplant. Bone Marrow Transplantation, 26(3), 333-8.
de Lima M, et al. High-dose Melphalan and Allogeneic Peripheral Blood Stem Cell Transplantation for Treatment of Early Relapse After Allogeneic Transplant. Bone Marrow Transplant. 2000;26(3):333-8. PubMed PMID: 10967575.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - High-dose melphalan and allogeneic peripheral blood stem cell transplantation for treatment of early relapse after allogeneic transplant. AU - de Lima,M, AU - van Besien,K, AU - Gajewski,J, AU - Khouri,I, AU - Andersson,B, AU - Korbling,M, AU - Champlin,R, AU - Giralt,S, PY - 2000/9/1/pubmed PY - 2001/2/28/medline PY - 2000/9/1/entrez SP - 333 EP - 8 JF - Bone marrow transplantation JO - Bone Marrow Transplant VL - 26 IS - 3 N2 - Patients with acute leukemias relapsing within 1 year of an allogeneic BMT have a poor prognosis. We studied the use of melphalan 180 mg/m2 followed by allogeneic peripheral blood stem cells (PBSC) as salvage treatment for patients relapsing after related (n = 7) or matched unrelated transplants (n = 3). Diagnoses were AML (n = 4), ALL (n = 3), biphenotypic acute leukemia (n = 2) and CML in blast crisis (n = 1). Eight patients were beyond first relapse and none were in remission. The median time from previous transplant to relapse was 146 days (range 66-206). The melphalan dose was 90 mg/m2 intravenously on days -4 and -3 with PBSC infusion on day 0. GVHD prophylaxis consisted of cyclosporine and methylprednisolone. The median time to an absolute neutrophil count >0.5 x 10(9)/l and to a platelet count >20 x 10(9)/l was 11 and 13 days, respectively. All engrafting patients (n = 8) had 100% donor cells. Two patients died before day 30, but no other grade 3 or 4 toxicity occurred. Acute GVHD grades II-III occurred in two subjects, and chronic GVHD in four. Seven patients achieved CR, but relapsed at a median of 116 days (range 56-614). Leukemia was the cause of death in eight patients. Median survival was 149 days (range 6-614). This treatment produced responses in the majority of this poor prognosis group. However, durable remissions were not observed, and new treatments to consolidate the responses achieved in this setting are needed. This regimen could be considered for short-term disease control to facilitate donor lymphocyte infusion-based immunotherapy or other measures to prevent disease recurrence. SN - 0268-3369 UR - https://www.unboundmedicine.com/medline/citation/10967575/High_dose_melphalan_and_allogeneic_peripheral_blood_stem_cell_transplantation_for_treatment_of_early_relapse_after_allogeneic_transplant_ L2 - https://doi.org/10.1038/sj.bmt.1702521 DB - PRIME DP - Unbound Medicine ER -