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Hematopoietic stem cell transplantation after reduced intensity conditioning in acute myelogenous leukemia patients older than 40 years.
Biol Blood Marrow Transplant. 2008 Feb; 14(2):181-6.BB

Abstract

Reduced intensity conditioning (RIC) protocols are increasingly used for allogeneic hematopoietic stem cell transplantation (HSCT) in elderly patients. We analyzed the outcome of RIC HSCT in acute myelogenous leukemia (AML) patients over the age of 40 years. Forty-three AML or high-risk myelodysplastic syndrome (MDS) patients were treated with a fludarabine and low-dose total-body irradiation (TBI)-based pretransplantation regimen. Donors were HLA-compatible sibling (68%) or unrelated volunteers (34%). All but 2 AML patients were in complete remission (CR) at the time of transplantation. Seventy-six percent of patients had a poor risk profile. Hematologic recovery was fast, and primary graft failure occurred in 1 patient. Two patients with active disease at the time of HSCT experienced ongoing relapse. Infections were diagnosed in 9 patients (21%), and 6 patients (14%) were treated for cytomegalovirus (CMV) reactivation. Sixty percent of patients developed acute graft-versus-host disease (aGVHD), which was grade II in 40% and grade III in 12%. The cumulative incidence of chronic graft-versus-host disease (cGVHD) was 33% at 1 and at 2 years. Treatment-related mortality (TRM) was low (9%), total nonrelapse mortality (NRM) was 19%. After a median follow-up of 571 days, 16 patients (37%) experienced relapse. Median disease-free and overall survival (DFS; OS) were 24 and 31 months, respectively. There were no differences in complications and outcome between recipients of sibling and unrelated grafts. In conclusion, fludarabine plus low-dose TBI-based RIC HSCT is effective in AML patients over the age of 40 years without active disease at the time of transplant and is associated with low TRM.

Authors+Show Affiliations

Department of Hematology, University Medical Center, Utrecht, The Netherlands. c.huisman@tiscali.nlNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article

Language

eng

PubMed ID

18215778

Citation

Huisman, Cynthia, et al. "Hematopoietic Stem Cell Transplantation After Reduced Intensity Conditioning in Acute Myelogenous Leukemia Patients Older Than 40 Years." Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation, vol. 14, no. 2, 2008, pp. 181-6.
Huisman C, Meijer E, Petersen EJ, et al. Hematopoietic stem cell transplantation after reduced intensity conditioning in acute myelogenous leukemia patients older than 40 years. Biol Blood Marrow Transplant. 2008;14(2):181-6.
Huisman, C., Meijer, E., Petersen, E. J., Lokhorst, H. M., & Verdonck, L. F. (2008). Hematopoietic stem cell transplantation after reduced intensity conditioning in acute myelogenous leukemia patients older than 40 years. Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation, 14(2), 181-6. https://doi.org/10.1016/j.bbmt.2007.09.017
Huisman C, et al. Hematopoietic Stem Cell Transplantation After Reduced Intensity Conditioning in Acute Myelogenous Leukemia Patients Older Than 40 Years. Biol Blood Marrow Transplant. 2008;14(2):181-6. PubMed PMID: 18215778.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hematopoietic stem cell transplantation after reduced intensity conditioning in acute myelogenous leukemia patients older than 40 years. AU - Huisman,Cynthia, AU - Meijer,Ellen, AU - Petersen,Eefke J, AU - Lokhorst,Henk M, AU - Verdonck,Leo F, Y1 - 2007/12/31/ PY - 2007/09/07/received PY - 2007/10/17/accepted PY - 2008/1/25/pubmed PY - 2008/3/28/medline PY - 2008/1/25/entrez SP - 181 EP - 6 JF - Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation JO - Biol Blood Marrow Transplant VL - 14 IS - 2 N2 - Reduced intensity conditioning (RIC) protocols are increasingly used for allogeneic hematopoietic stem cell transplantation (HSCT) in elderly patients. We analyzed the outcome of RIC HSCT in acute myelogenous leukemia (AML) patients over the age of 40 years. Forty-three AML or high-risk myelodysplastic syndrome (MDS) patients were treated with a fludarabine and low-dose total-body irradiation (TBI)-based pretransplantation regimen. Donors were HLA-compatible sibling (68%) or unrelated volunteers (34%). All but 2 AML patients were in complete remission (CR) at the time of transplantation. Seventy-six percent of patients had a poor risk profile. Hematologic recovery was fast, and primary graft failure occurred in 1 patient. Two patients with active disease at the time of HSCT experienced ongoing relapse. Infections were diagnosed in 9 patients (21%), and 6 patients (14%) were treated for cytomegalovirus (CMV) reactivation. Sixty percent of patients developed acute graft-versus-host disease (aGVHD), which was grade II in 40% and grade III in 12%. The cumulative incidence of chronic graft-versus-host disease (cGVHD) was 33% at 1 and at 2 years. Treatment-related mortality (TRM) was low (9%), total nonrelapse mortality (NRM) was 19%. After a median follow-up of 571 days, 16 patients (37%) experienced relapse. Median disease-free and overall survival (DFS; OS) were 24 and 31 months, respectively. There were no differences in complications and outcome between recipients of sibling and unrelated grafts. In conclusion, fludarabine plus low-dose TBI-based RIC HSCT is effective in AML patients over the age of 40 years without active disease at the time of transplant and is associated with low TRM. SN - 1523-6536 UR - https://www.unboundmedicine.com/medline/citation/18215778/Hematopoietic_stem_cell_transplantation_after_reduced_intensity_conditioning_in_acute_myelogenous_leukemia_patients_older_than_40_years_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1083-8791(07)00512-5 DB - PRIME DP - Unbound Medicine ER -