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Reduced-intensity allogeneic transplantation using alemtuzumab from HLA-matched related, unrelated, or haploidentical related donors for patients with hematologic malignancies.
Biol Blood Marrow Transplant. 2014 Feb; 20(2):257-63.BB

Abstract

We present a comparative study on 124 patients with hematologic malignancies who had undergone reduced-intensity conditioning and then received a transplant from an HLA-matched related (MRD), an HLA-matched unrelated (MUD), or an HLA-haploidentical related (HAPLO) donor. The conditioning regimen, which consisted of fludarabine, melphalan or busulfan, and alemtuzumab was administered to patients with lymphoid (n = 62) or myeloid disease (n = 62). Mycophenolate mofetil was used as prophylaxis for graft-versus-host disease (GVHD), and 38, 58, and 33 patients received transplants from MRD, MUD, and HAPLO donors, respectively. Only 2 patients experienced primary graft failure (GF) after melphalan-based regimen, whereas 8 of the 17 patients who received a transplant from HAPLO donors experienced a primary GF after busulfan-based regimen. The cumulative incidence of grade III to IV acute GVHD in engrafted patients who had received transplants from MRD, MUD, or HAPLO donors was 3%, 11%, and 27%, respectively, and the 2-year overall survival (OS) rates were 51%, 22%, and 23%, respectively. According to multivariate analysis, transplantation from either MUD or HAPLO donors compared with MRD were adverse factors that affected the OS (P = .006 and P = .002, respectively). In conclusion, the reduced-intensity regimen that included fludarabine, busulfan, or melphalan and alemtuzumab using only mycophenolate mofetil as the GVHD prophylaxis conferred favorable outcomes in the MRD group but lower survival rates in the MUD and HAPLO groups. The busulfan-based regimen led to a high incidence of GF in the HAPLO group, suggesting the need for modification or intensification of immunosuppression.

Authors+Show Affiliations

Adult Stem Cell Transplant Program, Division of Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, North Carolina; Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan. Electronic address: jkandajp@gmail.com.Adult Stem Cell Transplant Program, Division of Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, North Carolina.Adult Stem Cell Transplant Program, Division of Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, North Carolina.Adult Stem Cell Transplant Program, Division of Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, North Carolina.Adult Stem Cell Transplant Program, Division of Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, North Carolina.Adult Stem Cell Transplant Program, Division of Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, North Carolina.Adult Stem Cell Transplant Program, Division of Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, North Carolina.Adult Stem Cell Transplant Program, Division of Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, North Carolina.Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina.Adult Stem Cell Transplant Program, Division of Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, North Carolina.Adult Stem Cell Transplant Program, Division of Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, North Carolina.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

24269380

Citation

Kanda, Junya, et al. "Reduced-intensity Allogeneic Transplantation Using Alemtuzumab From HLA-matched Related, Unrelated, or Haploidentical Related Donors for Patients With Hematologic Malignancies." Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation, vol. 20, no. 2, 2014, pp. 257-63.
Kanda J, Long GD, Gasparetto C, et al. Reduced-intensity allogeneic transplantation using alemtuzumab from HLA-matched related, unrelated, or haploidentical related donors for patients with hematologic malignancies. Biol Blood Marrow Transplant. 2014;20(2):257-63.
Kanda, J., Long, G. D., Gasparetto, C., Horwitz, M. E., Sullivan, K. M., Chute, J. P., Morris, A., Shafique, M., Li, Z., Chao, N. J., & Rizzieri, D. A. (2014). Reduced-intensity allogeneic transplantation using alemtuzumab from HLA-matched related, unrelated, or haploidentical related donors for patients with hematologic malignancies. Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation, 20(2), 257-63. https://doi.org/10.1016/j.bbmt.2013.11.010
Kanda J, et al. Reduced-intensity Allogeneic Transplantation Using Alemtuzumab From HLA-matched Related, Unrelated, or Haploidentical Related Donors for Patients With Hematologic Malignancies. Biol Blood Marrow Transplant. 2014;20(2):257-63. PubMed PMID: 24269380.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Reduced-intensity allogeneic transplantation using alemtuzumab from HLA-matched related, unrelated, or haploidentical related donors for patients with hematologic malignancies. AU - Kanda,Junya, AU - Long,Gwynn D, AU - Gasparetto,Cristina, AU - Horwitz,Mitchell E, AU - Sullivan,Keith M, AU - Chute,John P, AU - Morris,Ashley, AU - Shafique,Michael, AU - Li,Zhiguo, AU - Chao,Nelson J, AU - Rizzieri,David A, Y1 - 2013/11/20/ PY - 2013/03/14/received PY - 2013/11/13/accepted PY - 2013/11/26/entrez PY - 2013/11/26/pubmed PY - 2014/11/5/medline KW - Alemtuzumab KW - Haploidentical KW - Matched-related KW - Matched-unrelated KW - Reduced-intensity SP - 257 EP - 63 JF - Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation JO - Biol. Blood Marrow Transplant. VL - 20 IS - 2 N2 - We present a comparative study on 124 patients with hematologic malignancies who had undergone reduced-intensity conditioning and then received a transplant from an HLA-matched related (MRD), an HLA-matched unrelated (MUD), or an HLA-haploidentical related (HAPLO) donor. The conditioning regimen, which consisted of fludarabine, melphalan or busulfan, and alemtuzumab was administered to patients with lymphoid (n = 62) or myeloid disease (n = 62). Mycophenolate mofetil was used as prophylaxis for graft-versus-host disease (GVHD), and 38, 58, and 33 patients received transplants from MRD, MUD, and HAPLO donors, respectively. Only 2 patients experienced primary graft failure (GF) after melphalan-based regimen, whereas 8 of the 17 patients who received a transplant from HAPLO donors experienced a primary GF after busulfan-based regimen. The cumulative incidence of grade III to IV acute GVHD in engrafted patients who had received transplants from MRD, MUD, or HAPLO donors was 3%, 11%, and 27%, respectively, and the 2-year overall survival (OS) rates were 51%, 22%, and 23%, respectively. According to multivariate analysis, transplantation from either MUD or HAPLO donors compared with MRD were adverse factors that affected the OS (P = .006 and P = .002, respectively). In conclusion, the reduced-intensity regimen that included fludarabine, busulfan, or melphalan and alemtuzumab using only mycophenolate mofetil as the GVHD prophylaxis conferred favorable outcomes in the MRD group but lower survival rates in the MUD and HAPLO groups. The busulfan-based regimen led to a high incidence of GF in the HAPLO group, suggesting the need for modification or intensification of immunosuppression. SN - 1523-6536 UR - https://www.unboundmedicine.com/medline/citation/24269380/Reduced_intensity_allogeneic_transplantation_using_alemtuzumab_from_HLA_matched_related_unrelated_or_haploidentical_related_donors_for_patients_with_hematologic_malignancies_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1083-8791(13)00529-6 DB - PRIME DP - Unbound Medicine ER -