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Unrelated Donor Transplants

Cyclosporine and mycophenolate mofetil prophylaxis with fludarabine and melphalan conditioning for unrelated donor transplantation: a prospective study of 22 patients with hematologic malignancies

Bone Marrow Transplantation volume 33, pages 1123–1129 (2004)Cite this article

Summary:

In an attempt to decrease toxicity in high-risk patients undergoing unrelated donor hematopoietic stem cell transplantation (URD HSCT), we tested a combination of cyclosporine (CSP) and mycophenolate mofetil (MMF) as graft-versus-host disease (GVHD) prophylaxis with the reduced-intensity conditioning regimen fludarabine/melphalan (Flu/Mel). A total of 22 adult patients with advanced myeloid (n=15) and lymphoid (n=7) malignancies were treated. All patients received Flu 25 mg/m2 for 5 days and Mel 140 mg/m2, with CSP 3 mg/kg daily and MMF 15 mg/kg three times a day. The median age was 49 years (range 18–66). Durable engraftment was seen in all but one patient with myelofibrosis. The 1-year nonrelapse mortality was 32%, 27% from GVHD. The cumulative incidence of acute GVHD grade 2–4 and 3–4 was 63 and 41%, respectively. With a median follow-up of 18 months, the disease-free survival (DFS) and overall survival (OS) are 55 and 59%, respectively. For patients with AML and MDS (n=14), the DFS and OS is 71%. For patients undergoing a second transplant (n=14), the DFS and OS is 57%. In conclusion, this regimen is associated with acceptable toxicity but high rates of GVHD in high-risk patients undergoing URD HSCT. Encouraging disease control for patients with advanced myeloid malignancies was observed.

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Acknowledgements

We acknowledge Diana Garcia for her assistance in manuscript preparation. We also thank other people who contributed to this study including Thomas Morrison, Allison Sano, Kathy Patane, and Popsie Gaytan.

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Authors and Affiliations

  1. City of Hope National Medical Center, Duarte, CA, USA

    R Rodriguez, P Parker, A Nademanee, D Smith, M R O'Donnell, A Stein, D S Snyder, H C Fung, A Y Krishnan, L Popplewell, S Cohen, G Somlo, M Angelopoulou, Z Al-Kadhimi, D Senitzer, M Slovak & S J Forman

  2. Southern California Permanente Medical Group, Los Angeles, CA, USA

    P M Falk, R Spielberger, N Kogut & F Sahebi

  3. City of Hope – Good Samaritan Bone Marrow Transplantation Program, Phoenix, AZ, USA

    J Schriber

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  1. R Rodriguez
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Correspondence to R Rodriguez.

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Rodriguez, R., Parker, P., Nademanee, A. et al. Cyclosporine and mycophenolate mofetil prophylaxis with fludarabine and melphalan conditioning for unrelated donor transplantation: a prospective study of 22 patients with hematologic malignancies. Bone Marrow Transplant 33, 1123–1129 (2004). https://doi.org/10.1038/sj.bmt.1704493

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  • DOI: https://doi.org/10.1038/sj.bmt.1704493

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