TY - JOUR
T1 - Second allogeneic stem cell transplantation using nonmyeloablative conditioning for patients who relapsed or developed secondary malignancies following autologous transplantation
AU - Nagler, Arnon
AU - Or, Reuven
AU - Naparstek, Elizabeth
AU - Varadi, Gabor
AU - Slavin, Shimon
N1 - Funding Information:
We would like to thank the following for their ongoing support: Baxter International Corporation; Ryna & Melvin Cohen; Joanne & David Morrison; Ronne & Donald Hess; Pep & Jerry Silverstein; The Szydlowsky Foundation; The Gabrielle Rich Leukemia Research Foundation; The Himmelfarb Foundation; The Danny Cunniff Leukemia Research Laboratory; The Cancer Treatment Foundation; and The German Israel Foundation.
PY - 2000/9
Y1 - 2000/9
N2 - Objective. Second allogeneic stem cell transplants for hematological malignancies are associated with a high incidence of transplant-related mortality due to the cumulative incidence of toxicity of the high-dose chemoradiotherapy traditionally used as an essential component of the conditioning. We have demonstrated previously that nonmyeloablative conditioning for primary allogeneic transplants from both sibling and unrelated donors results in minimal transplant-related toxicity and excellent stem cell engraftment. This study explores the possibility of using nonmyeloablative conditioning to minimize transplant-related toxicity in patients who have undergone second allogeneic transplants. Patients and Methods. Twelve high-risk, heavily treated patients - five with acute myelogenous leukemia (AML); five with non-Hodgkin's lymphoma (NHL); one with Burkitt's lymphoma, and one with acute lymphoblastic leukemia (ALL) - underwent second allogeneic nonmyeloablative stem cell transplantation (NST) from human leukocyte antigen (HLA)-matched donors, 29 (median) (range 3-57) months following their first transplantation procedure. The conditioning consisted of fludarabine 30 mg/m2 daily for 6 days, busulfan 4 mg/kg daily for 2 days, and anti-T-lymphocyte globulin 10 mg/kg daily for 4 days. Anti-graft-vs-host disease (anti-GVHD) prophylaxis consisted of cyclosporine A alone, 3 mg/kg. Results. Engraftment was observed in all recipients, with complete and stable chimerism. None of the patients developed veno-occlusive disease of the liver or multi-organ failure. Five very high-risk patients with NHL (n = 3), Burkitt's lymphoma (n = 1), and AML (n = 1) relapsed 2 to 6 months post-transplant, and four of them died. Six patients appear to be disease-free after median follow-up of 23 months. One additional patient died from grade IV hemorrhagic cystitis. Actuarial survival and disease-free survival at 34 months are 56% and 50% respectively, with 95% confidence interval (25-78%). Conclusion. These results suggest that nonmyeloablative conditioning significantly reduces transplant-related toxicity, thus making a second transplant feasible. (C) 2000 International Society for Experimental Hematology.
AB - Objective. Second allogeneic stem cell transplants for hematological malignancies are associated with a high incidence of transplant-related mortality due to the cumulative incidence of toxicity of the high-dose chemoradiotherapy traditionally used as an essential component of the conditioning. We have demonstrated previously that nonmyeloablative conditioning for primary allogeneic transplants from both sibling and unrelated donors results in minimal transplant-related toxicity and excellent stem cell engraftment. This study explores the possibility of using nonmyeloablative conditioning to minimize transplant-related toxicity in patients who have undergone second allogeneic transplants. Patients and Methods. Twelve high-risk, heavily treated patients - five with acute myelogenous leukemia (AML); five with non-Hodgkin's lymphoma (NHL); one with Burkitt's lymphoma, and one with acute lymphoblastic leukemia (ALL) - underwent second allogeneic nonmyeloablative stem cell transplantation (NST) from human leukocyte antigen (HLA)-matched donors, 29 (median) (range 3-57) months following their first transplantation procedure. The conditioning consisted of fludarabine 30 mg/m2 daily for 6 days, busulfan 4 mg/kg daily for 2 days, and anti-T-lymphocyte globulin 10 mg/kg daily for 4 days. Anti-graft-vs-host disease (anti-GVHD) prophylaxis consisted of cyclosporine A alone, 3 mg/kg. Results. Engraftment was observed in all recipients, with complete and stable chimerism. None of the patients developed veno-occlusive disease of the liver or multi-organ failure. Five very high-risk patients with NHL (n = 3), Burkitt's lymphoma (n = 1), and AML (n = 1) relapsed 2 to 6 months post-transplant, and four of them died. Six patients appear to be disease-free after median follow-up of 23 months. One additional patient died from grade IV hemorrhagic cystitis. Actuarial survival and disease-free survival at 34 months are 56% and 50% respectively, with 95% confidence interval (25-78%). Conclusion. These results suggest that nonmyeloablative conditioning significantly reduces transplant-related toxicity, thus making a second transplant feasible. (C) 2000 International Society for Experimental Hematology.
KW - Anti-T-lymphocyte globulin
KW - Fludarabine
KW - Nonmyeloablative
KW - Second transplantation
KW - Secondary tumors
UR - http://www.scopus.com/inward/record.url?scp=0033796947&partnerID=8YFLogxK
U2 - 10.1016/S0301-472X(00)00511-7
DO - 10.1016/S0301-472X(00)00511-7
M3 - ???researchoutput.researchoutputtypes.contributiontojournal.article???
AN - SCOPUS:0033796947
SN - 0301-472X
VL - 28
SP - 1096
EP - 1104
JO - Experimental Hematology
JF - Experimental Hematology
IS - 9
ER -
