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Reduced-intensity conditioning with busulfan and fludarabine with or without antithymocyte globulin in HLA-identical sibling transplantation--a retrospective analysis.
Bone Marrow Transplant. 2004 Mar; 33(5):483-90.BM

Abstract

It is unknown whether the addition of antithymocyte globulin (ATG) to reduced-intensity conditioning with busulfan (BU) and fludarabine (FLU) is beneficial in HLA-identical sibling transplantation. Therefore, we analyzed retrospectively data on 83 patients, who received peripheral blood stem cells from HLA-identical siblings after conditioning with either 8 mg/kg BU and 150 mg/m2 FLU (n=45) or 8 mg/kg BU, 180 mg/m2 FLU and 40 mg/kg ATG (n=38). Graft-versus-host disease (GVHD) prophylaxis consisted of CSA alone (n=32) or a combination with either MTX or MMF (n=51). The median age was 52 years. Graft failure occurred in two patients after BU/FLU and in three after BU/FLU/ATG (P=0.66). After conditioning with BU/FLU, platelet recovery was significantly faster (P=0.017), and less platelet (P<0.001) and red blood cell (P=0.002) support was needed. Incidences of acute GVHD grades II and IV were 46 and 49%, respectively. Limited chronic GVHD occurred more often after BU/FLU compared to BU/FLU/ATG (54 vs 23%, P=0.02). The overall survival, non-relapse and relapse mortality did not differ significantly. We conclude that in peripheral blood stem cell transplantation from HLA-identical siblings after reduced-intensity conditioning with BU and FLU, ATG has no major impact on the rate of graft rejection and acute GVHD, but it reduces the incidence of limited chronic GVHD.

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Authors+Show Affiliations

Schetelig J
Charité Campus Virchow Klinikum, Humboldt-Universität zu Berlin, Klinik für Innere Medizin mS Hämatologie und Onkologie, Berlin, Germany.
Bornhäuser M
No affiliation info available
Kiehl M
No affiliation info available
Schwerdtfeger R
No affiliation info available
Kröger N
No affiliation info available
Runde V
No affiliation info available
Zabelina T
No affiliation info available
Held TK
No affiliation info available
Thiede C
No affiliation info available
Fauser AA
No affiliation info available
Beelen D
No affiliation info available
Zander A
No affiliation info available
Ehninger G
No affiliation info available
Siegert W
No affiliation info available
Cooperative German Transplant Study Group
No affiliation info available

MeSH

Acute DiseaseAdultAgedAntilymphocyte SerumBusulfanChronic DiseaseCombined Modality TherapyFemaleFollow-Up StudiesGraft vs Host DiseaseHematologic NeoplasmsHematopoiesisHematopoietic Stem Cell TransplantationHistocompatibility TestingHumansImmunosuppressive AgentsIncidenceMaleMiddle AgedRecurrenceRetrospective StudiesSiblingsSurvival AnalysisTransplantation ConditioningTransplantation, HomologousTreatment FailureVidarabine

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

14716342

Citation

Schetelig, J, et al. "Reduced-intensity Conditioning With Busulfan and Fludarabine With or Without Antithymocyte Globulin in HLA-identical Sibling Transplantation--a Retrospective Analysis." Bone Marrow Transplantation, vol. 33, no. 5, 2004, pp. 483-90.
Schetelig J, Bornhäuser M, Kiehl M, et al. Reduced-intensity conditioning with busulfan and fludarabine with or without antithymocyte globulin in HLA-identical sibling transplantation--a retrospective analysis. Bone Marrow Transplant. 2004;33(5):483-90.
Schetelig, J., Bornhäuser, M., Kiehl, M., Schwerdtfeger, R., Kröger, N., Runde, V., Zabelina, T., Held, T. K., Thiede, C., Fauser, A. A., Beelen, D., Zander, A., Ehninger, G., & Siegert, W. (2004). Reduced-intensity conditioning with busulfan and fludarabine with or without antithymocyte globulin in HLA-identical sibling transplantation--a retrospective analysis. Bone Marrow Transplantation, 33(5), 483-90.
Schetelig J, et al. Reduced-intensity Conditioning With Busulfan and Fludarabine With or Without Antithymocyte Globulin in HLA-identical Sibling Transplantation--a Retrospective Analysis. Bone Marrow Transplant. 2004;33(5):483-90. PubMed PMID: 14716342.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Reduced-intensity conditioning with busulfan and fludarabine with or without antithymocyte globulin in HLA-identical sibling transplantation--a retrospective analysis. AU - Schetelig,J, AU - Bornhäuser,M, AU - Kiehl,M, AU - Schwerdtfeger,R, AU - Kröger,N, AU - Runde,V, AU - Zabelina,T, AU - Held,T K, AU - Thiede,C, AU - Fauser,A A, AU - Beelen,D, AU - Zander,A, AU - Ehninger,G, AU - Siegert,W, AU - ,, PY - 2004/1/13/pubmed PY - 2004/9/29/medline PY - 2004/1/13/entrez SP - 483 EP - 90 JF - Bone marrow transplantation JO - Bone Marrow Transplant VL - 33 IS - 5 N2 - It is unknown whether the addition of antithymocyte globulin (ATG) to reduced-intensity conditioning with busulfan (BU) and fludarabine (FLU) is beneficial in HLA-identical sibling transplantation. Therefore, we analyzed retrospectively data on 83 patients, who received peripheral blood stem cells from HLA-identical siblings after conditioning with either 8 mg/kg BU and 150 mg/m2 FLU (n=45) or 8 mg/kg BU, 180 mg/m2 FLU and 40 mg/kg ATG (n=38). Graft-versus-host disease (GVHD) prophylaxis consisted of CSA alone (n=32) or a combination with either MTX or MMF (n=51). The median age was 52 years. Graft failure occurred in two patients after BU/FLU and in three after BU/FLU/ATG (P=0.66). After conditioning with BU/FLU, platelet recovery was significantly faster (P=0.017), and less platelet (P<0.001) and red blood cell (P=0.002) support was needed. Incidences of acute GVHD grades II and IV were 46 and 49%, respectively. Limited chronic GVHD occurred more often after BU/FLU compared to BU/FLU/ATG (54 vs 23%, P=0.02). The overall survival, non-relapse and relapse mortality did not differ significantly. We conclude that in peripheral blood stem cell transplantation from HLA-identical siblings after reduced-intensity conditioning with BU and FLU, ATG has no major impact on the rate of graft rejection and acute GVHD, but it reduces the incidence of limited chronic GVHD. SN - 0268-3369 UR - https://www.unboundmedicine.com/medline/citation/14716342/Reduced_intensity_conditioning_with_busulfan_and_fludarabine_with_or_without_antithymocyte_globulin_in_HLA_identical_sibling_transplantation__a_retrospective_analysis_ L2 - https://doi.org/10.1038/sj.bmt.1704384 DB - PRIME DP - Unbound Medicine ER -
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