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Unrelated donor bone marrow transplantation without T cell depletion using a chemotherapy only condition regimen. Low incidence of failed engraftment and severe acute GVHD.
Bone Marrow Transplant. 1996 Apr; 17(4):549-54.BM

Abstract

Twenty-five patients with hematologic malignancies were treated with busulfan (16 mg/kg) and cyclophosphamide (50 mg/kg x 3 days) as conditioning for bone marrow transplantation using marrow from serologically matched, DR locus genotypically identical unrelated donors. Previous studies of BuCy2 as conditioning for UD-BMT have reported a graft failure rate of up to 21% suggesting it may be insufficiently immunosuppressive in this setting. We elected not to use BuCy4 as it may have a higher incidence of extramedullary toxicity. In addition the patients received GM-CSF (500 mg/m2) from day 0, cyclosporine and short-course methotrexate (15 mg/m2 x 1, then 10 mg/m2 x 3) as GVHD prophylaxis and prophylactic ganciclovir at engraftment if either they or their donor were CMV antibody positive. The median age of the 25 patients was 41 years and the most common diagnosis was CML (76%). Seven patients were considered poor risk and eight males were recipients of marrow from female donors. Sixteen patients survive at a median of 435 days from transplant. The actuarial overall and disease-free survivals at 1 year in this group of older patients were 62 +/- 20% and 57 +/- 20% and 100-day survival was 70%. The engraftment rate was 100%; there have been no instances of secondary graft failure. Fifteen patients (60%) developed grade II-IV GVHD and 12 of 16 (75%) developed some chronic GVHD but only half of these were extensive. The performance status of survivors is good (median of 90); seven of 12 eligible patients are back at work. This study demonstrates that UD-BMT can be successfully performed in very closely HLA-matched older patients using a chemotherapy-only protocol and that low rates of severe acute GVHD can be achieved without T cell depletion.

Authors+Show Affiliations

Department of Neoplastic Diseases, Hahnemann University Hospital, Philadelphia, PA 19102, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

8722353

Citation

Topolsky, D, et al. "Unrelated Donor Bone Marrow Transplantation Without T Cell Depletion Using a Chemotherapy Only Condition Regimen. Low Incidence of Failed Engraftment and Severe Acute GVHD." Bone Marrow Transplantation, vol. 17, no. 4, 1996, pp. 549-54.
Topolsky D, Crilley P, Styler MJ, et al. Unrelated donor bone marrow transplantation without T cell depletion using a chemotherapy only condition regimen. Low incidence of failed engraftment and severe acute GVHD. Bone Marrow Transplant. 1996;17(4):549-54.
Topolsky, D., Crilley, P., Styler, M. J., Bulova, S., Brodsky, I., & Marks, D. I. (1996). Unrelated donor bone marrow transplantation without T cell depletion using a chemotherapy only condition regimen. Low incidence of failed engraftment and severe acute GVHD. Bone Marrow Transplantation, 17(4), 549-54.
Topolsky D, et al. Unrelated Donor Bone Marrow Transplantation Without T Cell Depletion Using a Chemotherapy Only Condition Regimen. Low Incidence of Failed Engraftment and Severe Acute GVHD. Bone Marrow Transplant. 1996;17(4):549-54. PubMed PMID: 8722353.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Unrelated donor bone marrow transplantation without T cell depletion using a chemotherapy only condition regimen. Low incidence of failed engraftment and severe acute GVHD. AU - Topolsky,D, AU - Crilley,P, AU - Styler,M J, AU - Bulova,S, AU - Brodsky,I, AU - Marks,D I, PY - 1996/4/1/pubmed PY - 1996/4/1/medline PY - 1996/4/1/entrez SP - 549 EP - 54 JF - Bone marrow transplantation JO - Bone Marrow Transplant VL - 17 IS - 4 N2 - Twenty-five patients with hematologic malignancies were treated with busulfan (16 mg/kg) and cyclophosphamide (50 mg/kg x 3 days) as conditioning for bone marrow transplantation using marrow from serologically matched, DR locus genotypically identical unrelated donors. Previous studies of BuCy2 as conditioning for UD-BMT have reported a graft failure rate of up to 21% suggesting it may be insufficiently immunosuppressive in this setting. We elected not to use BuCy4 as it may have a higher incidence of extramedullary toxicity. In addition the patients received GM-CSF (500 mg/m2) from day 0, cyclosporine and short-course methotrexate (15 mg/m2 x 1, then 10 mg/m2 x 3) as GVHD prophylaxis and prophylactic ganciclovir at engraftment if either they or their donor were CMV antibody positive. The median age of the 25 patients was 41 years and the most common diagnosis was CML (76%). Seven patients were considered poor risk and eight males were recipients of marrow from female donors. Sixteen patients survive at a median of 435 days from transplant. The actuarial overall and disease-free survivals at 1 year in this group of older patients were 62 +/- 20% and 57 +/- 20% and 100-day survival was 70%. The engraftment rate was 100%; there have been no instances of secondary graft failure. Fifteen patients (60%) developed grade II-IV GVHD and 12 of 16 (75%) developed some chronic GVHD but only half of these were extensive. The performance status of survivors is good (median of 90); seven of 12 eligible patients are back at work. This study demonstrates that UD-BMT can be successfully performed in very closely HLA-matched older patients using a chemotherapy-only protocol and that low rates of severe acute GVHD can be achieved without T cell depletion. SN - 0268-3369 UR - https://www.unboundmedicine.com/medline/citation/8722353/Unrelated_donor_bone_marrow_transplantation_without_T_cell_depletion_using_a_chemotherapy_only_condition_regimen__Low_incidence_of_failed_engraftment_and_severe_acute_GVHD_ L2 - http://www.diseaseinfosearch.org/result/7171 DB - PRIME DP - Unbound Medicine ER -