Non-myeloablative conditioning for lower-risk myelodysplastic syndrome with bone marrow blasts less than 5 %-a feasibility study.

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  • Additional Information
    • Source:
      Publisher: Springer Verlag Country of Publication: Germany NLM ID: 9107334 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1432-0584 (Electronic) Linking ISSN: 09395555 NLM ISO Abbreviation: Ann Hematol Subsets: MEDLINE
    • Publication Information:
      Publication: Berlin : Springer Verlag
      Original Publication: Berlin ; New York : Springer International, c1991-
    • Subject Terms:
      Bone Marrow Cells/*pathology ; Hematopoietic Stem Cell Transplantation/*methods ; Myelodysplastic Syndromes/*diagnosis ; Myelodysplastic Syndromes/*therapy ; Transplantation Conditioning/*methods; Adolescent ; Adult ; Antilymphocyte Serum/administration & dosage ; Bone Marrow Cells/drug effects ; Busulfan/administration & dosage ; Cyclophosphamide/administration & dosage ; Feasibility Studies ; Female ; Humans ; Male ; Middle Aged ; Transplantation, Homologous/methods ; Vidarabine/administration & dosage ; Vidarabine/analogs & derivatives ; Young Adult
    • Abstract:
      Reduced-intensity conditioning (RIC) regimens can cause decreased non-relapse mortality (NRM) but lead to higher relapse rates in higher-risk myelodysplastic syndrome (MDS). However, relapse is not the main problem after hematopoietic cell transplantation (HCT) in lower-risk MDS, and post-transplant outcomes may therefore improve with less intense non-myeloablative conditioning (NMC) regimens. We here report the results of a single-center feasibility study of NMC with cyclophosphamide-fludarabine-antithymocyte globulin (CyFluATG) in MDS patients with bone marrow blasts <5 %. We compared post-transplant outcomes between CyFluATG and a RIC regimen, busulfan-fludarabine-antithymocyte globulin (BuFluATG). Fifteen MDS patients received allogeneic HCT after CyFluATG conditioning comprising cyclophosphamide (100 mg/kg), fludarabine (150 mg/m(2)), and ATG, and 30 MDS historical control patients received BuFluATG conditioning which contained busulfan (8 [oral] or 6.4 [i.v.] mg/kg), fludarabine, and ATG. The 4-year overall survival (OS) and NRM rates were 80.0 and 20.0 % for CyFluATG and 73.3 and 20.0 % for BuFluATG, respectively. Neutrophil and platelet engraftment was significantly faster with CyFluATG than BuFluATG (median 12 vs. 14 days, P = 0.005 for neutrophils; median 15 vs. 21 days, P = 0.032 for platelets). CyFluATG produced a faster immune reconstitution of T-cells at 1 month after HCT than BuFluATG. Fertility was maintained after HCT with CyFluATG. In conclusion, the CyFluATG regimen is feasible in lower-risk MDS patients in terms of adequate engraftment and low NRM.
    • Contributed Indexing:
      Keywords: Cyclophosphamide; Hematopoietic cell transplantation; Lower-risk; Myelodysplastic syndrome; Non-myeloablative conditioning
    • Accession Number:
      0 (Antilymphocyte Serum)
      8N3DW7272P (Cyclophosphamide)
      FA2DM6879K (Vidarabine)
      G1LN9045DK (Busulfan)
      P2K93U8740 (fludarabine)
    • Publication Date:
      Date Created: 20160424 Date Completed: 20170127 Latest Revision: 20170127
    • Publication Date:
      20231215
    • Accession Number:
      10.1007/s00277-016-2679-x
    • Accession Number:
      27106699