Clinical effect of reduced‐intensity conditioning regimen containing antithymocyte globulin for hematopoietic cell transplantation from unrelated‐donors

• Published in: American journal of hematology Vol. 86; no. 5; pp. 399 - 405
• Main Authors: Lee, Kyoo‐Hyung, Choi, Seong‐Jun, Lee, Je‐Hwan, Lee, Jung‐Hee, Kim, Dae‐Young, Seol, Miee, Lee, Young‐Shin, Kang, Young‐Ah, Jeon, Mijin, Yun, Sung‐Cheol, Joo, Young‐Don, Lee, Won‐Sik, Kang, Myoung‐Joo, Kim, Hawk, Park, Jae‐Hoo, Bae, Sung‐Hwa, Ryoo, Hun‐Mo, Kim, Min‐Kyoung, Hyun, Myung‐Soo
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01.05.2011; Wiley-Liss; Wiley Subscription Services, Inc
• Subjects: Adolescent; Adult; Antilymphocyte Serum - therapeutic use; Antineoplastic Agents - administration & dosage; Antineoplastic Agents - therapeutic use; Biological and medical sciences; Bone Marrow Transplantation - adverse effects; Bone Marrow Transplantation - mortality; Busulfan - administration & dosage; Busulfan - therapeutic use; Graft Survival - drug effects; Graft vs Host Disease - prevention & control; Hematologic and hematopoietic diseases; Hematology; Hematopoietic Stem Cell Transplantation - adverse effects; Hematopoietic Stem Cell Transplantation - mortality; Humans; Immunosuppressive Agents - therapeutic use; Leukemia, Myeloid, Acute - therapy; Medical Records; Medical sciences; Middle Aged; Myelodysplastic Syndromes - therapy; Peripheral Blood Stem Cell Transplantation - adverse effects; Peripheral Blood Stem Cell Transplantation - mortality; Precursor Cell Lymphoblastic Leukemia-Lymphoma - therapy; Retrospective Studies; Survival Analysis; Transplantation Conditioning - methods; Vidarabine - analogs & derivatives; Vidarabine - therapeutic use; Young Adult; Treatment; Hematology; Unrelated donor; Stem cell; Immunotherapy; Hematopoietic cell; Homograft; Graft; Non myeloablative treatment; Therapeutic protocol; Antithymocyte globulin
• ISSN: 0361-8609; 1096-8652; 1096-8652
• DOI: 10.1002/ajh.21989

The impact of reduced‐intensity conditioning (RIC) on the outcomes of hematopoietic cell transplantation (HCT) from unrelated ‐donors (UD) remains to be determined. We therefore assessed 128 patients, aged 16 to 66 years, with acute leukemia (n = 105) or myelodysplastic syndrome (n = 23) in a UD‐HCT trial using RIC with busulfan, fludarabine, and antithymocyte globulin. Patients were transplanted with unmanipulated bone marrow (BM, n = 41) or mobilized peripheral blood mononuclear cells (M‐PB, n = 87) and received cyclosporine and methotrexate for graft‐versus‐host disease (GVHD) prophylaxis. After a median follow‐up of 26.7 months (range, 5.9−70.7 months) in surviving patients, 19 patients had died without progression/recurrence of underlying disease, giving a cumulative incidence of transplantation‐related mortality (TRM) of 17% (95% confidence interval, 11%–27%; 1‐year TRM, 14%). Graft failure (n = 7) and infections (n = 5) were the most common causes of TRM. Only three patients died due to GVHD (acute, one; chronic, two). Graft failure, which occurred in eight patients, showed a significant correlation with graft source (BM, 6/41 vs. M‐PB, 2/87; P = 0.009). Donor‐patient HLA‐disparity did not correlate with GVHD, 1‐year TRM, and graft failure. RIC containing antithymocyte globulin led to decreased GVHD‐associated, as well as overall, TRM after UD‐HCT. This trial is registered at www.clinicaltrials.gov as NCT00627666. Am. J. Hematol. 86:399–405,2011. © 2011 Wiley‐Liss, Inc.