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Alternative Donor Transplants

Alternative donor transplants for patients with advanced hematologic malignancies, conditioned with thiotepa, cyclophosphamide and antithymocyte globulin

Bone Marrow Transplantation volume 26, pages 1305–1311 (2000)Cite this article

Abstract

Preparative regimens without total body irradiation (TBI) have been reported for alternative donor hemopoietic stem cell transplants (HSCT). Between 7 September 1994 and 7 June 1999 48 patients with advanced hematologic malignancies were conditioned with thiotepa (THIO) 15 mg/kg, cyclophosphamide (CY) 150 mg/kg and antithymocyte globulin (ATG). Donors were HLA mismatched family members (1–2 antigens) (FAM) (n = 24, median age 31 years) or HLA matched unrelated donors (UD) (n = 24, median age 34 years). GVHD prophylaxis was cyclosporine and methotrexate. Stem cell source was peripheral blood (n = 8) or bone marrow (n = 40). Hematologic recovery was seen in 42/46 (91%) evaluable patients and complete chimerism in 31/37 patients (85%). Acute GVHD grades III–IV were seen in 10/46 patients surviving 10 days (21%) and extensive chronic GVHD in 2/36 patients surviving 100 days (5%). Twenty-six patients died (54%), eight of recurrent disease (17%) and 18 of transplant-related complications (37%): main causes of TRM were GVHD (15%), infections (15%) and graft failure (4%). Twenty-two patients (46%) survive with a median follow-up of 877 days (287–1840). The actuarial 3-year survival is 49% for FAM and 42% for UD transplants. Results obtained with this regimen in unrelated grafts for advanced CML (n = 15) were not significantly different when compared to 21 concurrent UD grafts for advanced CML prepared with CY-TBI. In conclusion, the combination of THIO-CY-ATG allows engraftment of alternative donor hemopoietic stem cells. Results are similar when using unrelated matched donors or partially mismatched family donors, and not significantly different when compared to patients conditioned with CY-TBI. Bone Marrow Transplantation (2000) 26, 1305–1311.

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Acknowledgements

This work was supported by Associazione Italiana Ricerca contro il Cancro (AIRC) Milano grant to AB, Associazione Italiana contro le Leucemie (AIL) Sezione Genova and Associazione Ricerca Trapianto Midollo Osseo (ARITMO) Genova. The great work of our nursing staff is gratefully acknowledged.

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Authors and Affiliations

  1. Dipartimento di Ematologia, Ospedale San Martino, Genova, Italy

    T Lamparelli, MT van Lint, F Gualandi, AM Raiola, S Bregante, G Berisso, A Dominietto, CDi Grazia, B Bruno & A Bacigalupo

  2. Italian Bone Marrow Transplant Registry (IBMDR), Genova, Italy

    M Barbanti, N Sacchi, G Ficai & C Ghinatti

  3. Dipartimento Medicina Interna (DIMI), Genova, Italy

    M Sessarego

  4. Cattedra Medicina Legale, Università, Genova, Italy

    L Casarino & S Verdiani

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  1. T Lamparelli
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Lamparelli, T., van Lint, M., Gualandi, F. et al. Alternative donor transplants for patients with advanced hematologic malignancies, conditioned with thiotepa, cyclophosphamide and antithymocyte globulin. Bone Marrow Transplant 26, 1305–1311 (2000). https://doi.org/10.1038/sj.bmt.1702719

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