Long-term results of allogeneic hematopoietic stem cell transplantation after reduced-intensity conditioning with busulfan, fludarabine, and antithymocyte globulin

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Authors

KREJČÍ Marta BRYCHTOVÁ Yvona DOUBEK Michael TOMIŠKA Miroslav NAVRÁTIL Milan RÁČIL Zdeněk DVOŘÁKOVÁ Dana HORKÝ Ondřej LENGEROVÁ Martina POSPÍŠILOVÁ Šárka MAYER Jiří

Year of publication 2011
Type Article in Periodical
Magazine / Source Neoplasma
MU Faculty or unit

Faculty of Medicine

Citation
Doi http://dx.doi.org/10.4149/neo_2011_05_406
Field Oncology and hematology
Keywords reduced-intensity conditioning; fludarabine; busulfan; antithymocyte globulin
Description Reduced-intensity conditioning (RIG) is widely used for allogeneic stem cell transplantation (SCT). Here we present our long-term experience with RIG regimen consisting of fludarabine (30 mg/m(2)/day on days -10 to -5), busulfan (4mg/kg/day on days -6 and -5) and antithymocyte globulin (ATG Fresenius, 10 mg/kg/day on days -4 to -1) (Flu-Bu-ATG) in a cohort of 71 patients with various hematological malignancies including chronic myeloid leukemia (24 patients), acute myeloid leukemia (19 patients), lymphoma (20 patients), multiple myeloma (3 patients), myelodysplastic syndrome (3 patients), and myelofibrosis (2 patients). The median age was 50 years. The overall response rate was 87%, including 83% CR and 4% PR. The incidence of acute and chronic GVHD was 35% and 52% and the cumulative incidence of non-relapse mortality at 1 year and 4 years was 8% and 14%. With the median follow-up of 55.0 months, the 2- and 4-year event-free survival (EFS) was 49.0% and 40.3%, and the overall survival (OS) was 73.2% and 62.6%, respectively. Gender, age at SCT, type of donor, disease status at SCT, previous autologous transplantation, and complete chimerism by day +100 did not significantly influence EFS and OS. In a multivariate analysis, no presence of chronic GVHD (p=0.029, HR: 2.5),and diagnosis other than CML (p=0.018, HR: 4.6), and CD34+ dose < 5x10(6)/kg (p=0.010, HR: 2.8) were significant predictors of poor OS. Flu-Bu-ATG protocol is a RIG regimen that combines effective disease control with low non-relapse mortality and acceptable toxicity profile.
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