[en] Purpose We have used a nonmyelorablative conditioning regimen consisting of total-body irradiation (2 Gy) with or without fludarabine (30 mg/m(2)/d for 3 days) for related and unrelated hematopoietic cell transplantation (HCT) in patients with hematologic malignancies who were not candidates for conventional HCT because of age, medical comorbidities, or preceding high-dose HCT. This approach relied on graft-versus-tumor (GVT) effects for control of malignancy. Patients and Methods We analyzed GVT effects in 322 patients given grafts from HILA-matched related (n = 192) or unrelated donors (n = 130). Results Of the 221 patients with measurable disease at HCT, 126 (57%) achieved complete (n = 98) or partial (n = 28) remissions. In multivariate analysis, there was a higher probability trend of achieving complete remissions in patients with chronic extensive graft-versus-host disease (GVHD, P = .07). One hundred eight patients (34%) relapsed or progressed. In multivariate analysis, achievement of full donor chimerism was associated with a decreased risk of relapse or progression (P = .002). Grade 2 to 4 acute GVHD had no significant impact on the risk of relapse or progression but was associated with increased risk of nonrelapse mortality and decreased probability of progression-free survival (PFS). Conversely, extensive chronic GVHD was associated with decreased risk of relapse or progression (P = .006) and increased probability of PFS (P = .003). Conclusion New approaches aimed at reducing the incidence of grade 2 to 4 acute GVHD might improve survival after allogeneic HCT after nonmyeloablative conditioning. (c) 2005 by American Society of Clinical Oncology.
Disciplines :
Hematology Oncology
Author, co-author :
Baron, Frédéric ; Université de Liège - ULiège > Département des sciences cliniques > Hématologie
Maris, M. B.
Sandmaier, B. M.
Storer, B. E.
Sorror, M.
Diaconescu, R.
Woolfrey, A. E.
Chauncey, T. R.
Flowers, M. E. D.
Mielcarck, M.
Maloney, D. G.
Storb, R.
Language :
English
Title :
Graft-versus-tumor effects after allogeneic hematopoietic cell transplantation with nonmyeloablative conditioning
Publication date :
20 March 2005
Journal title :
Journal of Clinical Oncology
ISSN :
0732-183X
eISSN :
1527-7755
Publisher :
Amer Soc Clinical Oncology, Alexandria, U.S. Virgin Islands
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