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Conditioning Regimens

Fludarabine phosphate and melphalan: a reduced intensity conditioning regimen suitable for allogeneic transplantation that maintains the graft versus malignancy effect

Bone Marrow Transplantation volume 37, pages 455–461 (2006)Cite this article

Abstract

Reduced intensity conditioning (RIC) for allogeneic stem cell transplantation allows stable donor cell engraftment with the maintenance of a graft versus malignancy effect. Many different regimens exist employing various combinations of chemotherapy, radiotherapy and T-cell depletion. We examined the role of non-T-cell depleted RIC regimens in 56 patients with haematological malignancies. Patients received fludarabine phosphate for 5 days (30 mg/m2 in 35 patients, 25 mg/m2 in 21 patients) and melphalan for 1 day (140 mg/m2 in 36 patients, 100 mg/m2 in 20 patients). Immunosuppression was with CyA alone in 33 patients and CyA/MTX in 23 patients. Twenty-four of the 26 patients with chimerism data showed >95% donor chimerism at 3 months post transplant. aGVHD occurred in 18% of patients receiving CyA/MTX compared to 53% of patients receiving CyA. The 100-day mortality rate was 0.16 (95%CI 0.08–0.28) and 1-year nonrelapse mortality was 0.24 (95%CI 0.13–0.38). Thirty-three patients remained alive and in CR at a median of 19 months post transplant (range 3–38 months). We have shown that patients transplanted with fludarabine phosphate, melphalan 100 mg/m2 and with CyA/MTX as post transplant immunosuppression can achieve good disease control with an acceptable level of toxicity. Further studies are required to confirm these findings.

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Acknowledgements

The authors would like to acknowledge the contribution of Ralph Bloomfield, Senior Statistician at Schering Health Care Limited. This work was supported by Schering Germany. Professor GJ Morgan is supported by the Leukaemia Research Fund. Three of the authors were employed by a company (Schering Health Care Limited) whose product was studied in the present work, and these authors were involved in the management of the company-sponsored clinical trial.

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Authors and Affiliations

  1. Department of Haematology, University Hospital Aintree, Liverpool, UK

    R K Dasgupta

  2. Derriford Hospital, Plymouth, UK

    S Rule

  3. Western General Hospital, Edinburgh, UK

    P Johnson & J Davies

  4. University Hospital of Wales, Cardiff, UK

    A Burnett, C Poynton & K Wilson

  5. The General Infirmary, Leeds, UK

    G M Smith

  6. Royal Victoria Infirmary, Newcastle, UK

    G Jackson & C Richardson

  7. Schering Health Care Limited, Burgess Hill, UK

    E Wareham, A C Stars & S M Tollerfield

  8. The Royal Marsden Hospital, Sutton, UK

    G J Morgan

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Correspondence to R K Dasgupta.

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Dasgupta, R., Rule, S., Johnson, P. et al. Fludarabine phosphate and melphalan: a reduced intensity conditioning regimen suitable for allogeneic transplantation that maintains the graft versus malignancy effect. Bone Marrow Transplant 37, 455–461 (2006). https://doi.org/10.1038/sj.bmt.1705271

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