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Brychtová Y., Krejčí M., Doubek M., Tomíška M., Navrátil M., Ráčil Z., Dvořáková D., Horký O., Lengerová M., Pospíšilová S., Mayer J.: Long-term results of allogeneic hematopoietic stem cell transplantation after a reduced-intensity conditioning busulfan, fludarabine, and antithymocyte globulin


Authors: Y. Brychtová;  M. Krejčí;  M. Doubek;  M. Tomíška;  M. Navrátil;  Z. Ráčil;  D. Dvořáková;  O. Horký;  M. Lengerová;  S. Pospíšilová;  J. Mayer
Authors‘ workplace: Interní hematoonkologická klinika, Fakultní nemocnice Brno, Lékařská fakulta Masarykova Univerzita Brno
Published in: Transfuze Hematol. dnes,17, 2011, No. 1, p. 12-19.
Category: Comprehensive Reports, Original Papers, Case Reports

Overview

Reduced-intensity conditioning (RIC) is being widely used for allogeneic stem cell transplantation (SCT). Here we present our long-term experience with RIC regimen consisting of fludarabine (6x30 mg/m2), busulfan (2x4 mg/kg) and antithymocyte globulin (ATG Fresenius, 4x10 mg/kg) (Flu-Bu-ATG) at cohort of 71 patients (pts) with various hematological malignancies, 65 pts had unrelated donor, 6 related donor. Patients were transplanted in period 1998-2008, aim of our work was to evaluate effectivity and toxicity of RIC Flu-Bu-ATG. Median age was 50 years. Overall response rate was 87%; 83% of pts achieved complete and 4% partial response. The incidence of acute and chronic GVHD was 35% and 52%. The cumulative incidence of non-relapse mortality after 1 year and 4 years were 8% and 14%, respectively. With median follow-up of 55.0 months after SCT, 2- and 4-year event-free survival (EFS) was 49.0% and 40.3%, overall survival (OS) was 73.2% and 62.6%. Gender, age at SCT, type of donor, disease status at SCT, previous autologous transplantation, achievement of complete chimerism to day +100 did not significantly influence EFS and OS. On multivariate analysis, no presence of chronic GVHD (p = 0.029, HR:2.5), other diagnosis than CML (p = 0.018, HR:4.6) and dose of CD34+ cells lower than 5x106/kg (p = 0.010, HR:2.8) are statistically significant for shorter OS. In conclusion, the Flu-Bu-ATG protocol can be considered as a RIC regimen combining effective disease control and acceptable toxicity profil.

Key words:
reduced-intensity conditioning, fludarabine, busufan, antithymocyte globulin


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Labels
Haematology Internal medicine Clinical oncology

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