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Engraftment kinetics and hematopoietic chimerism after reduced-intensity conditioning with fludarabine and treosulfan before allogeneic stem cell transplantation.
Ann Hematol. 2007 Aug; 86(8):583-9.AH

Abstract

Reduced-intensity conditioning with fludarabine and treosulfan before allogeneic stem cell transplantation (SCT) was introduced several years ago. Although its feasibility has recently been proven, only limited data are available on myelotoxicity, engraftment kinetics, and the significance of hematopoietic chimerism using this novel conditioning regimen. To clarify these open questions, we analyzed 27 patients with various hematological diseases, who received allogeneic SCT preceded by fludarabine/treosulfan conditioning. Further assessment endpoints included graft-vs-host disease (GvHD), mortality, and overall survival (OS). Allogeneic SCT was followed by neutropenia (absolute neutrophil count < or = 0.5 x 10(9)/l) and thrombocytopenia (platelets < or = 20 x 10(9)/l) in all patients. All patients showed stable neutrophil engraftment, and all except one had stable platelet engraftment. Grades II-IV acute GvHD was found in 48% of patients, whereas 52% developed chronic GvHD. The treatment-related mortality on day +100, 1 year after SCT, and at the last follow-up was 11, 26, and 33%, respectively. We found complete chimerism rates of 46, 57, and 72% on days +28, +56, and at the last follow-up or before death, respectively. The underlying malignancy tended to relapse more frequently in patients with mixed chimerism than in those with complete chimerism on day +28 as well as on day +56 (not significant). Additionally, no significant association was found between hematopoietic chimerism and donor type, GvHD, or OS, respectively. We conclude that reduced-intensity conditioning with fludarabine and treosulfan before allogeneic SCT is myeloablative, provides stable engraftment, and leads to complete chimerism in the majority of patients.

Authors+Show Affiliations

Medizinische Klinik III (Hämatologie, Onkologie und Transfusionsmedizin), Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany.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)

Journal Article

Language

eng

PubMed ID

17468869

Citation

Blau, I W., et al. "Engraftment Kinetics and Hematopoietic Chimerism After Reduced-intensity Conditioning With Fludarabine and Treosulfan Before Allogeneic Stem Cell Transplantation." Annals of Hematology, vol. 86, no. 8, 2007, pp. 583-9.
Blau IW, Schmidt-Hieber M, Leschinger N, et al. Engraftment kinetics and hematopoietic chimerism after reduced-intensity conditioning with fludarabine and treosulfan before allogeneic stem cell transplantation. Ann Hematol. 2007;86(8):583-9.
Blau, I. W., Schmidt-Hieber, M., Leschinger, N., Göldner, H., Knauf, W., Hopfenmüller, W., Thiel, E., & Blau, O. (2007). Engraftment kinetics and hematopoietic chimerism after reduced-intensity conditioning with fludarabine and treosulfan before allogeneic stem cell transplantation. Annals of Hematology, 86(8), 583-9.
Blau IW, et al. Engraftment Kinetics and Hematopoietic Chimerism After Reduced-intensity Conditioning With Fludarabine and Treosulfan Before Allogeneic Stem Cell Transplantation. Ann Hematol. 2007;86(8):583-9. PubMed PMID: 17468869.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Engraftment kinetics and hematopoietic chimerism after reduced-intensity conditioning with fludarabine and treosulfan before allogeneic stem cell transplantation. AU - Blau,I W, AU - Schmidt-Hieber,Martin, AU - Leschinger,N, AU - Göldner,H, AU - Knauf,W, AU - Hopfenmüller,W, AU - Thiel,E, AU - Blau,O, Y1 - 2007/04/28/ PY - 2006/12/01/received PY - 2007/03/30/accepted PY - 2007/5/1/pubmed PY - 2007/12/6/medline PY - 2007/5/1/entrez SP - 583 EP - 9 JF - Annals of hematology JO - Ann Hematol VL - 86 IS - 8 N2 - Reduced-intensity conditioning with fludarabine and treosulfan before allogeneic stem cell transplantation (SCT) was introduced several years ago. Although its feasibility has recently been proven, only limited data are available on myelotoxicity, engraftment kinetics, and the significance of hematopoietic chimerism using this novel conditioning regimen. To clarify these open questions, we analyzed 27 patients with various hematological diseases, who received allogeneic SCT preceded by fludarabine/treosulfan conditioning. Further assessment endpoints included graft-vs-host disease (GvHD), mortality, and overall survival (OS). Allogeneic SCT was followed by neutropenia (absolute neutrophil count < or = 0.5 x 10(9)/l) and thrombocytopenia (platelets < or = 20 x 10(9)/l) in all patients. All patients showed stable neutrophil engraftment, and all except one had stable platelet engraftment. Grades II-IV acute GvHD was found in 48% of patients, whereas 52% developed chronic GvHD. The treatment-related mortality on day +100, 1 year after SCT, and at the last follow-up was 11, 26, and 33%, respectively. We found complete chimerism rates of 46, 57, and 72% on days +28, +56, and at the last follow-up or before death, respectively. The underlying malignancy tended to relapse more frequently in patients with mixed chimerism than in those with complete chimerism on day +28 as well as on day +56 (not significant). Additionally, no significant association was found between hematopoietic chimerism and donor type, GvHD, or OS, respectively. We conclude that reduced-intensity conditioning with fludarabine and treosulfan before allogeneic SCT is myeloablative, provides stable engraftment, and leads to complete chimerism in the majority of patients. SN - 0939-5555 UR - https://www.unboundmedicine.com/medline/citation/17468869/Engraftment_kinetics_and_hematopoietic_chimerism_after_reduced_intensity_conditioning_with_fludarabine_and_treosulfan_before_allogeneic_stem_cell_transplantation_ L2 - https://dx.doi.org/10.1007/s00277-007-0294-6 DB - PRIME DP - Unbound Medicine ER -