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Unmanipulated haploidentical bone marrow transplantation and post-transplant cyclophosphamide for hematologic malignanices following a myeloablative conditioning: an update.
Bone Marrow Transplant. 2015 Jun; 50 Suppl 2:S37-9.BM

Abstract

This is a report of 148 patients with hematologic malignancies who received an unmanipulated haploidentical bone marrow transplant (BMT), followed by post-transplant high-dose cyclophosphamide (PT-CY). All patients received a myeloablative conditioning consisting of thiotepa, busulfan, fludarabine (n=92) or TBI, fludarabine (n=56). The median age was 47 years (17-74); 47 patients were in first remission (CR1), 37 in second remission (CR2) and 64 had an active disease; all patients were first grafts. The diagnosis was acute leukemia (n=75), myelodisplastic syndrome (n=24), myelofibrosis (n=16), high-grade lymphoma (n=15) and others (n=18). GVHD prophylaxis consisted in PT-CY on days +3 and +5, cyclosporine (from day 0), and mycophenolate (from day +1). The median day for neutrophil engraftment was day +18 (13-32). The cumulative incidence of grades II-IV acute GVHD was 24%, and of grades III-IV GVHD 10%. The incidence of moderate-severe chronic GVHD was 12%. With a median follow-up for the surviving patients of 313 days (100-1162), the cumulative incidence of transplant-related mortality (TRM) is 13%, and the relapse-related death is 23%. The actuarial 22 months overall survival is 77% for CR1 patients, 49% for CR2 patients and 38% for patients grafted in relapse (P<0.001). Major causes of death were relapse (22%), GVHD (2%) and infections (6%). We confirm our initial results, suggesting that a myeloablative conditioning regimen followed by unmanipulated haploidentical BMT with PT-CY, results in a low risk of acute and chronic GVHD and encouraging rates of TRM and overall survival, also for patients with active disease at the time of transplant.

Authors+Show Affiliations

Divisione Ematologia e Trapianto di Midollo, IRCCS San Martino, Genova, Italy.Divisione Ematologia e Trapianto di Midollo, IRCCS San Martino, Genova, Italy.Divisione Ematologia e Trapianto di Midollo, IRCCS San Martino, Genova, Italy.Divisione Ematologia e Trapianto di Midollo, IRCCS San Martino, Genova, Italy.Divisione Ematologia e Trapianto di Midollo, IRCCS San Martino, Genova, Italy.Divisione Ematologia e Trapianto di Midollo, IRCCS San Martino, Genova, Italy.Divisione Ematologia e Trapianto di Midollo, IRCCS San Martino, Genova, Italy.Divisione Ematologia e Trapianto di Midollo, IRCCS San Martino, Genova, Italy.Divisione Ematologia e Trapianto di Midollo, IRCCS San Martino, Genova, Italy.Divisione Ematologia e Trapianto di Midollo, IRCCS San Martino, Genova, Italy.Divisione Ematologia e Trapianto di Midollo, IRCCS San Martino, Genova, Italy.Divisione Ematologia e Trapianto di Midollo, IRCCS San Martino, Genova, Italy.Divisione Ematologia e Trapianto di Midollo, IRCCS San Martino, Genova, Italy.Divisione Ematologia e Trapianto di Midollo, IRCCS San Martino, Genova, Italy.Divisione Ematologia e Trapianto di Midollo, IRCCS San Martino, Genova, Italy.Divisione Ematologia e Trapianto di Midollo, IRCCS San Martino, Genova, Italy.

Pub Type(s)

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

Language

eng

PubMed ID

26039205

Citation

Bacigalupo, A, et al. "Unmanipulated Haploidentical Bone Marrow Transplantation and Post-transplant Cyclophosphamide for Hematologic Malignanices Following a Myeloablative Conditioning: an Update." Bone Marrow Transplantation, vol. 50 Suppl 2, 2015, pp. S37-9.
Bacigalupo A, Dominietto A, Ghiso A, et al. Unmanipulated haploidentical bone marrow transplantation and post-transplant cyclophosphamide for hematologic malignanices following a myeloablative conditioning: an update. Bone Marrow Transplant. 2015;50 Suppl 2:S37-9.
Bacigalupo, A., Dominietto, A., Ghiso, A., Di Grazia, C., Lamparelli, T., Gualandi, F., Bregante, S., Van Lint, M. T., Geroldi, S., Luchetti, S., Grasso, R., Pozzi, S., Colombo, N., Tedone, E., Varaldo, R., & Raiola, A. M. (2015). Unmanipulated haploidentical bone marrow transplantation and post-transplant cyclophosphamide for hematologic malignanices following a myeloablative conditioning: an update. Bone Marrow Transplantation, 50 Suppl 2, S37-9. https://doi.org/10.1038/bmt.2015.93
Bacigalupo A, et al. Unmanipulated Haploidentical Bone Marrow Transplantation and Post-transplant Cyclophosphamide for Hematologic Malignanices Following a Myeloablative Conditioning: an Update. Bone Marrow Transplant. 2015;50 Suppl 2:S37-9. PubMed PMID: 26039205.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Unmanipulated haploidentical bone marrow transplantation and post-transplant cyclophosphamide for hematologic malignanices following a myeloablative conditioning: an update. AU - Bacigalupo,A, AU - Dominietto,A, AU - Ghiso,A, AU - Di Grazia,C, AU - Lamparelli,T, AU - Gualandi,F, AU - Bregante,S, AU - Van Lint,M T, AU - Geroldi,S, AU - Luchetti,S, AU - Grasso,R, AU - Pozzi,S, AU - Colombo,N, AU - Tedone,E, AU - Varaldo,R, AU - Raiola,A M, PY - 2015/6/4/entrez PY - 2015/6/4/pubmed PY - 2016/2/24/medline SP - S37 EP - 9 JF - Bone marrow transplantation JO - Bone Marrow Transplant. VL - 50 Suppl 2 N2 - This is a report of 148 patients with hematologic malignancies who received an unmanipulated haploidentical bone marrow transplant (BMT), followed by post-transplant high-dose cyclophosphamide (PT-CY). All patients received a myeloablative conditioning consisting of thiotepa, busulfan, fludarabine (n=92) or TBI, fludarabine (n=56). The median age was 47 years (17-74); 47 patients were in first remission (CR1), 37 in second remission (CR2) and 64 had an active disease; all patients were first grafts. The diagnosis was acute leukemia (n=75), myelodisplastic syndrome (n=24), myelofibrosis (n=16), high-grade lymphoma (n=15) and others (n=18). GVHD prophylaxis consisted in PT-CY on days +3 and +5, cyclosporine (from day 0), and mycophenolate (from day +1). The median day for neutrophil engraftment was day +18 (13-32). The cumulative incidence of grades II-IV acute GVHD was 24%, and of grades III-IV GVHD 10%. The incidence of moderate-severe chronic GVHD was 12%. With a median follow-up for the surviving patients of 313 days (100-1162), the cumulative incidence of transplant-related mortality (TRM) is 13%, and the relapse-related death is 23%. The actuarial 22 months overall survival is 77% for CR1 patients, 49% for CR2 patients and 38% for patients grafted in relapse (P<0.001). Major causes of death were relapse (22%), GVHD (2%) and infections (6%). We confirm our initial results, suggesting that a myeloablative conditioning regimen followed by unmanipulated haploidentical BMT with PT-CY, results in a low risk of acute and chronic GVHD and encouraging rates of TRM and overall survival, also for patients with active disease at the time of transplant. SN - 1476-5365 UR - https://www.unboundmedicine.com/medline/citation/26039205/Unmanipulated_haploidentical_bone_marrow_transplantation_and_post_transplant_cyclophosphamide_for_hematologic_malignanices_following_a_myeloablative_conditioning:_an_update_ L2 - http://dx.doi.org/10.1038/bmt.2015.93 DB - PRIME DP - Unbound Medicine ER -