Low-dose total body irradiation and fludarabine conditioning for HLA class I-mismatched donor stem cell transplantation and immunologic recovery in patients with hematologic malignancies: a multicenter trial.

Publication Type:

Journal Article

Source:

Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation, Volume 16, Issue 3, p.384-94 (2010)

Keywords:

2010, Adolescent, Adult, Aged, Blood Cell Count, Cell Count, Center-Authored Paper, Clinical Research Division, Communicable Diseases, DENDRITIC CELLS, Disease-Free Survival, Female, Graft Rejection, Graft vs Host Disease, Hematologic Neoplasms, Histocompatibility, Histocompatibility Antigens Class I, Humans, Kaplan-Meier Estimate, LYMPHOCYTES, Male, Middle Aged, Myeloablative Agonists, Peripheral Blood Stem Cell Transplantation, Postoperative Complications, RECURRENCE, Research Trials Office Core Facility - Biostatistics Service, Shared Resources, T-Lymphocytes, Tissue Donors, Transplantation Chimera, Transplantation Conditioning, Treatment Outcome, Vidarabine, Whole-Body Irradiation, Young Adult

Abstract:

HLA-mismatched grafts are a viable alternative source for patients without HLA-matched donors receiving ablative hematopoietic cell transplantation (HCT), although their use in reduced intensity conditioning (RIC) or nonmyeloablative (NMA) conditioning HCT has been not well established. Here, we extended HCT to recipients of HLA class I-mismatched grafts to investigate whether NMA conditioning can establish stable donor engraftment. Fifty-nine patients were conditioned with fludarabine (Flu) 90 mg/m(2) and 2 Gy total body irradiation (TBI), followed by immunosuppression with cyclosporine (CsA) 5.0 mg/kg twice a day and mycophenolate mofetil (MMF) 15 mg/kg 3 times a day for transplantation of granulocyte colony-stimulating factor (G-CSF)-mobilized peripheral blood stem cells (PBSCs) from related (n = 5) or unrelated donors (n = 54) with 1 antigen +/- 1 allele HLA class I mismatch or 2 HLA class I allele mismatches. Sustained donor engraftment was observed in 95% of the evaluable patients. The incidence of grade II-IV acute and extensive chronic graft-versus-host disease (aGVHD, cGVHD) was 69% and 41%, respectively. The cumulative probability of nonrelapse mortality (NRM) was 47% at 2 years. Two-year overall and progression-free survival (OS, PFS) was 29% and 28%, respectively. NMA conditioning with Flu and low-dose TBI, followed by HCT using HLA class I-mismatched donors leads to successful engraftment and long-term survival; however, the high incidence of aGVHD and NRM needs to be addressed by alternate GVHD prophylaxis regimens.