» Articles » PMID: 12697870

Allogeneic Stem-cell Transplantation from Related and Unrelated Donors in Older Patients with Myeloid Leukemia

Overview
Journal J Clin Oncol
Specialty Oncology
Date 2003 Apr 17
PMID 12697870
Citations 37
Authors
Affiliations
Soon will be listed here.
Abstract

Purpose: To improve outcome for older patients with poor-prognosis myeloid malignancies by using allogeneic hematopoietic stem-cell transplantation (alloHSCT) from unrelated and sibling donors after reduced-intensity conditioning (RIC).

Patients And Methods: Nineteen older patients (median age, 64 years; range, 60 to 70 years) with active myeloid malignancies were treated with an RIC regimen that was based on fludarabine, melphalan, and carmustine followed by alloHSCT from matched unrelated (n = 12) or sibling donors (n = 7). Before transplantation, patients had a median of 50% bone marrow blasts (range, 0% to 70%). Graft-versus-host-disease (GvHD) prophylaxis consisted of cyclosporine and mycophenolate mofetil or methotrexate. Eleven of 12 patients with an unrelated donor also received anti-T-lymphocyte globulin (ATG).

Results: Engraftment was successful for all 19 patients. Seventeen assessable patients achieved complete response (CR). Four patients experienced relapse; three achieved CR again after donor lymphocyte infusion (n = 1) or a second alloHSCT (n = 2). Six patients died as a result of relapse (n = 2), GvHD-associated complications (n = 2), or fungal infections (n = 2), resulting in a 1-year nonrelapse mortality rate of 22%. With a median follow-up of 825 days (range, 595 to 1,028 days), 13 of 19 patients are alive, resulting in a 1-year survival rate of 68% (95% confidence interval, 48% to 89%).

Conclusion: In older patients with untreated poor-prognosis leukemia, this RIC regimen combined with alloHSCT sufficiently reduces the leukemic burden, resulting in a high CR rate. When ATG is added, matched unrelated donor transplantation can be performed safely in older patients. For these patients, early transplantation after diagnosis offers a fair chance of cure.

Citing Articles

Long-term follow-up of patients with acute myeloid leukemia undergoing allogeneic hematopoietic stem cell transplantation after primary induction failure.

Mozaffari Jovein M, Ihorst G, Duque-Afonso J, Wasch R, Bertz H, Wehr C Blood Cancer J. 2023; 13(1):179.

PMID: 38071327 PMC: 10710471. DOI: 10.1038/s41408-023-00953-0.


Comparison of fludarabine/melphalan (FluMel) with fludarabine/melphalan/BCNU or thiotepa (FBM/FTM) in patients with AML in first complete remission undergoing allogeneic hematopoietic stem cell transplantation - a registry study on behalf of the....

Duque-Afonso J, Finke J, Ngoya M, Galimard J, Craddock C, Raj K Bone Marrow Transplant. 2023; 59(2):247-254.

PMID: 38040842 PMC: 10849951. DOI: 10.1038/s41409-023-02150-w.


The graft-versus-leukemia effect of prophylactic donor lymphocyte infusions after allogeneic stem cell transplantation is equally effective in relapse prevention but safer compared to spontaneous graft-versus-host disease.

Stadler M, Hambach L, Dammann E, Diedrich H, Kamal H, Hamwi I Ann Hematol. 2023; 102(9):2529-2542.

PMID: 37490114 PMC: 10444690. DOI: 10.1007/s00277-023-05276-5.


Rehabilitation after Allogeneic Haematopoietic Stem Cell Transplantation: A Special Challenge.

Bertz H Cancers (Basel). 2021; 13(24).

PMID: 34944808 PMC: 8699253. DOI: 10.3390/cancers13246187.


Evolving Therapeutic Approaches for Older Patients with Acute Myeloid Leukemia in 2021.

Urbino I, Secreto C, Olivi M, Apolito V, DArdia S, Frairia C Cancers (Basel). 2021; 13(20).

PMID: 34680226 PMC: 8534216. DOI: 10.3390/cancers13205075.