TY - JOUR
T1 - Reduced-intensity stem cell transplantation from an HLA-identical sibling donor in patients with myeloid malignancies
AU - Hamaki, T.
AU - Kami, M.
AU - Kim, S. W.
AU - Onishi, Y.
AU - Kishi, Y.
AU - Murashige, N.
AU - Hori, A.
AU - Kojima, R.
AU - Sakiyama, M.
AU - Imataki, O.
AU - Heike, Y.
AU - Tanosaki, R.
AU - Masuo, S.
AU - Miyakoshi, S.
AU - Taniguchi, S.
AU - Tobinai, K.
AU - Takaue, Y.
PY - 2004/5
Y1 - 2004/5
N2 - The purpose of this study was to evaluate the feasibility and efficacy of allogeneic hematopoietic stem cell transplantation with a reduced-intensity regimen (RIST) in patients with acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS). In all, 36 patients (median age 55 years) underwent RIST from an HLA-matched related donor between September 1999 and December 2002. The diagnoses included AML (n = 14), leukemia evolving from MDS (n = 10), and MDS (refractory anemia with excess blasts n = 6, refractory anemia n = 6). The RIST regimen consisted of purine analog (cladribine or fludarabine)/busulfan, with or without antithymocyte globulin. The regimen was well tolerated, and 34 patients achieved durable engraftment and most achieved remission after RIST. A total of 17 patients developed grade II-IV acute GVHD, and 27 developed chronic GVHD. Eight patients relapsed, and five of them received antithymocyte globulin (ATG) as part of the preparative regimen. A total of 12 patients died (four disease progression, six transplantation-related complications, and two others). Estimated 1-year disease-free survival (DFS) in low- and high-risk groups was 85 and 64%, respectively. We conclude that RIST can be performed safely in elderly patients with myeloid malignancies, and has therapeutic potential for those who fail conventional chemotherapy. In view of the significant association between GVHD or ATG and DFS, defined management of GVHD following RIST should become a major target of clinical research.
AB - The purpose of this study was to evaluate the feasibility and efficacy of allogeneic hematopoietic stem cell transplantation with a reduced-intensity regimen (RIST) in patients with acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS). In all, 36 patients (median age 55 years) underwent RIST from an HLA-matched related donor between September 1999 and December 2002. The diagnoses included AML (n = 14), leukemia evolving from MDS (n = 10), and MDS (refractory anemia with excess blasts n = 6, refractory anemia n = 6). The RIST regimen consisted of purine analog (cladribine or fludarabine)/busulfan, with or without antithymocyte globulin. The regimen was well tolerated, and 34 patients achieved durable engraftment and most achieved remission after RIST. A total of 17 patients developed grade II-IV acute GVHD, and 27 developed chronic GVHD. Eight patients relapsed, and five of them received antithymocyte globulin (ATG) as part of the preparative regimen. A total of 12 patients died (four disease progression, six transplantation-related complications, and two others). Estimated 1-year disease-free survival (DFS) in low- and high-risk groups was 85 and 64%, respectively. We conclude that RIST can be performed safely in elderly patients with myeloid malignancies, and has therapeutic potential for those who fail conventional chemotherapy. In view of the significant association between GVHD or ATG and DFS, defined management of GVHD following RIST should become a major target of clinical research.
KW - Acute myeloid leukemia
KW - Graft-versus-host disease
KW - Graft-versus-leukemia effect
KW - Myelodysplastic syndrome
KW - Reduced-intensity hematopoietic stem cell transplantation
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U2 - 10.1038/sj.bmt.1704477
DO - 10.1038/sj.bmt.1704477
M3 - Article
C2 - 15048142
AN - SCOPUS:2442662929
SN - 0268-3369
VL - 33
SP - 891
EP - 900
JO - Bone Marrow Transplantation
JF - Bone Marrow Transplantation
IS - 9
ER -