Abstract
In this study, we retrospectively evaluated the efficacy and safety of total body irradiation (TBI) and granulocyte colony-stimulating factor (G-CSF)-combined high-dose cytarabine as a conditioning regimen for allogeneic hematopoietic stem cell transplantation (HSCT) in patients with advanced myelodysplastic syndrome (MDS). We evaluated 22 patients with advanced MDS, including refractory anemia with excess blasts (RAEB; n=10), RAEB in transformation (n=2), acute myelogenous leukemia transformed from MDS (n=6) and chronic myelomonocytic leukemia (n=4). The conditioning regimen consisted of 12 Gy of TBI and high-dose cytarabine (3 g/m2) every 12 h for 4 days, and the cytarabine was combined with continuous administration of G-CSF. The stem cell sources were bone marrow or peripheral blood stem cells from human leukocyte antigen (HLA)-identical siblings (n=12) and bone marrow from HLA serologically matched unrelated donors (n=10). Three patients experienced disease relapse, two of whom died of disease progression. Of 22 patients, 16 are currently alive and disease-free. The 5-year estimated overall survival, disease-free survival, relapse and non-relapse mortality rates are 76.7, 72.2, 16.6 and 14.1%, respectively. These results suggest that G-CSF-combined high-dose cytarabine could be a promising component of the conditioning regimen of allogeneic HSCT for advanced MDS, providing a low incidence of both relapse and treatment-related mortality.
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References
Sutton L, Chastand C, Ribaud P, Jouet J-P, Kuentz M, Attal M et al. Factors influencing outcome in de novo myelodysplastic syndromes treated by allogeneic bone marrow transplantation: a long-term study of 71 patients. Blood 1996; 88: 358–365.
Runde V, De Witte T, Arnold R, Gratwohl A, Hemans J, Van Biezen A et al. Bone marrow transplantation from HLA-identical siblings as first-line treatment in patients with myelodysplastic syndromes: early transplantation is associated with improved outcome. Bone Marrow Transplant 1998; 21: 255–261.
Sierra J, Perez WS, Rozman C, Carreras E, Klein JP, Rizzo JD et al. Bone marrow transplantation from HLA-identical siblings as treatment for myelodysplasia. Blood 2002; 100: 1997–2004.
De Witte T, Hermans J, Vossen J, Bacigalup A, Meloni G, Jacobsen N et al. Haematopoietic stem cell transplantation for patients with myelodysplastic syndromes and secondary acute leukaemias: a report on behalf of the Chronic Leukaemia Working Party of the European Group for Blood and Marrow Transplantation (EBMT). Br J Haematol 2000; 110: 620–630.
Deeg HJ, Storer B, Slattery JT, Anasetti C, Doney KC, Hansen JA et al. Conditioning with targeted busulfan and cyclophosphamide for hemopoietic stem cell transplantation from related and unrelated donors in patients with myelodysplastic syndrome. Blood 2002; 100: 1201–1207.
Anderson JE, Anasetti C, Appelbaum FR, Schoch G, Gooley TA, Hasen JA et al. Unrelated donor marrow transplantation for myelodysplasia (MDS) and MDS-related acute myeloid leukaemia. Br J Haematol 1996; 93: 59–67.
Arnold R, De Witte T, Van Biezen A, Hermans J, Jacobsen N, Runde V et al. Unrelated bone marrow transplantation in patients with myelodysplastic syndromes and secondary acute myeloid leukemia: an EBMT survey. Bone Marrow Transplant 1998; 21: 1213–1216.
Castro-Malaspina H, Harris RE, Gajewski J, Ramsay N, Collins R, Dharan B et al. Unrelated donor marrow transplantation for myelodysplastic syndromes: outcome analysis in 510 transplants facilitated by the National Marrow Donor Program. Blood 2002; 99: 1943–1951.
Miyauchi J, Kelleher CA, Wang C, Minkin S, McCuloch EA . Growth factors influence the sensitivity of leukemic stem cells to cytosine arabinoside in culture. Blood 1989; 73: 1272–1278.
Waga K, Furusawa S, Nagashima S, Saito K, Shishido H . Comparative effects of G-CSF, GM-CSF, and IL-3 on cytosine arabinoside- and daunorubicin-mediated cytotoxicity of acute myeloid leukemia cells and normal myeloid progenitors. Int J Hematol 1992; 56: 17–27.
Takahashi S, Okamoto S-I, Shirafuji N, Ikebuchi K, Tani K, Shimane M et al. Recombinant human glycosylated granulocyte colony-stimulating factor (rhG-CSF)-combined regimen for allogeneic bone marrow transplantation in refractory acute myeloid leukemia. Bone Marrow Transplant 1994; 13: 239–245.
Tafuri A, De Felice L, Petrucci MT, Grazia M, Mascolo MG, Ricciardi MR et al. Multidrug resistance expression and proliferative studies in poor risk acute myeloid leukemia treated with the FLAG (G-CSF plus fludarabine and Ara-C) regimen. Cytokine Mol Ther 1995; 1: 301–307.
Estey F, Thall P, Andreeff M, Beran M, Kantarjian H, O′Brien S et al. Use of granulocyte colony-stimulating factor before, during, and after fludarabine plus cytarabine induction therapy of newly diagnosed acute myelogenous leukemia or myelodysplastic syndromes: comparison with fludarabine plus cytarabine without granulocyte colony-stimulating factor. J Clin Oncol 1994; 12: 671–678.
Saito K, Nakamura Y, Aoyagi M, Waga K, Yamamoto K, Aoyagi A et al. Low-dose cytarabine and aclarubicin in combination with granulocyte colony-stimulating factor (CAG regimen) for previously treated patients with relapsed or primary resistant acute myelogenous leukemia (AML) and previously untreated elderly patients with AML, secondary AML, and refractory anemia with excess of blasts in transformation. Int J Hematol 2000; 71: 238–244.
Lowenberg B, van Putten W, Theobald M, Gmur J, Verdonck L, Sonneveld P et al. Effect of priming with granulocyte colony-stimulating factor on the outcome of chemotherapy for acute leukemia. N Engl J Med 2003; 349: 743–752.
Okamoto S, Takahashi S, Wakui M, Ishida A, Tanosaki R, Ikeda Y et al. Treatment of advanced myelodysplastic syndrome with a regimen including recombinant human granulocyte colony-stimulating factor preceding allogeneic bone marrow transplantation. Br J Haematol 1999; 104: 569–573.
Takahashi S, Oshima Y, Okamoto S-I, Nishiwaki K, Nagayama H, Inoue T et al. Recombinant human granulocyte colony-stimulating factor (G-CSF) combined conditioning regimen for allogeneic bone marrow transplantation (BMT) in standard-risk myeloid leukemia. Am J Hematol 1998; 57: 303–308.
Przepiorka D, Weisdorf D, Martin P, Klingemann HG, Beatty P, Hows J et al. Consensus conference on acute GVHD grading. Bone Marrow Transplant 1995; 15: 825–828.
Shulman HM, Sullivan KM, Weiden PL, McDonald GB, Striker GE, Sale GE et al. Chronic graft-versus-host syndrome in man: a long-term clinicopathologic study of 20 Seattle patients. Am J Med 1980; 69: 204–217.
Nakai K, Kanda Y, Fukuhara S, Sakamaki H, Okamoto S, Kodera Y et al. Value of chemotherapy before allogeneic hematopoietic stem cell transplantation from an HLA-identical sibling donor for myelodysplastic syndrome. Leukemia 2005; 19: 396–401.
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Mori, T., Aisa, Y., Yokoyama, A. et al. Total body irradiation and granulocyte colony-stimulating factor-combined high-dose cytarabine as a conditioning regimen in allogeneic hematopoietic stem cell transplantation for advanced myelodysplastic syndrome: a single-institute experience. Bone Marrow Transplant 39, 217–221 (2007). https://doi.org/10.1038/sj.bmt.1705578
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DOI: https://doi.org/10.1038/sj.bmt.1705578
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