Salvage allogeneic hematopoietic cell transplantation with fludarabine and low-dose total body irradiation after rejection of first allografts.

Publication Type:

Journal Article

Source:

Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation, Volume 15, Issue 10, p.1314-22 (2009)

Keywords:

2009, Acute Disease, Adolescent, Adult, Aged, Anemia, Aplastic, Center-Authored Paper, Child, Chronic Disease, Clinical Research Division, Female, Follow-Up Studies, Graft Rejection, Graft vs Host Disease, hematopoietic stem cell transplantation, Humans, Living Donors, Male, Middle Aged, Myeloablative Agonists, Neoplasms, Public Health Sciences Division, RECURRENCE, Research Trials Office Core Facility - Biostatistics Service, Retrospective Studies, Salvage Therapy, Shared Resources, Transplantation Conditioning, Transplantation, Homologous, Vidarabine, Whole-Body Irradiation

Abstract:

We summarized results in 38 consecutive patients (median age=56 years) with hematologic malignancies (n=35), aplastic anemia (n=2), or renal cell carcinoma (n=1), who underwent salvage hematopoietic cell transplantation (HCT) for allograft rejection. In 14 patients, the original donors were used for salvage HCT, and, in 24 cases, different donors were used. Conditioning for salvage HCT consisted of fludarabine (Flu) and either 3 or 4 Gy total body irradiation (TBI). Sustained engraftment was achieved in 33 patients (87%). Grafts were rejected in 5 patients (13%), 4 of whom had myelofibrosis. With a median follow-up of 2 years (range: 0.3 to 7.8 years), the 2- and 4-year estimated survivals were 49% and 42%, respectively. The 2-year relapse rate and nonrelapse mortality (NRM) were 36% and 24%, respectively. The 2-year cumulative incidences of grades II-IV acute and moderate-severe chronic graft-versus-host disease (aGVHD, cGVHD) were 42% and 41%, respectively. In this cohort, TBI dose, grafts from original versus different donors, related versus unrelated donors, and HCT comorbidity scores did not have an impact on outcomes. We concluded that graft rejection after allogeneic HCT could be overcome by salvage transplantation using conditioning with Flu and low-dose TBI.