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Allografting

Comparable non-relapse mortality and survival after HLA-identical sibling blood stem cell transplantation with reduced or conventional-intensity preparative regimens for high-risk myelodysplasia or acute myeloid leukemia in first remission

Bone Marrow Transplantation volume 41, pages 33–38 (2008)Cite this article

Abstract

We prospectively compared two strategies of allogeneic PBSCT from HLA-identical siblings in adults with poor-risk AML or myelodysplastic syndrome with >5% marrow blasts in an early disease status (AML or refractory anemia with excess blasts (RAEB type 2) in first remission after chemotherapy or untreated RAEB type 1). Based only on age, all consecutive patients were offered one of two specific transplant protocols. Patients ⩽50 years old received conventional high-dose conditioning with cyclophosphamide-TBI and use of CD34+-selected PBSCT (CTCD34+ group), while patients aged >50 years received a reduced-intensity conditioning (RIC) with fludarabine and oral busulphan (FB-RIC). Seventy-five patients entered the study (35 in the CTCD34+ and 39 in the FB-RIC group). The median follow-up was >4 years in both groups. The 4-year non-relapse mortality (NRM) was 19 and 20%, respectively (P=0.8). Relapse and survival were also equivalent in both groups. These results suggest that in this setting, the expected high NRM in elderly patients can be reduced with an RIC regimen.

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Acknowledgements

This study was performed in the setting of the CETLAM cooperative group (Grupo Cooperativo para el Estudio y Tratamiento de las Leucemias Agudas y Mielodisplasias, protocols CET-LAM-99 and CET-LAM-2003), in part with grants C03/010 and 603/008 from the Instituto de Salud Carlos III and two grants from Fundació d’Investigació Sant Pau and Fundació ‘La Caixa’ (Barcelona, Spain).

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  1. Division of Clinical Hematology, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain

    R Martino, D Valcárcel, S Brunet, A Sureda & J Sierra

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  1. R Martino
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  2. D Valcárcel
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  3. S Brunet
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Correspondence to R Martino.

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Specific contribution(s) of each coauthor: RM: conceived and executed the research reported in the paper, the integrity and data analysis, was involved in patient care and wrote the various versions of the manuscript. In addition, he also had the task of data management and statistical analyses. DV: collaborated in patient care, data management and the statistical analyses. All other co-authors contributed in the conception and execution of the research reported in the paper and in-patient care, and participated in writing or interpreting relevant parts of the manuscript.

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Martino, R., Valcárcel, D., Brunet, S. et al. Comparable non-relapse mortality and survival after HLA-identical sibling blood stem cell transplantation with reduced or conventional-intensity preparative regimens for high-risk myelodysplasia or acute myeloid leukemia in first remission. Bone Marrow Transplant 41, 33–38 (2008). https://doi.org/10.1038/sj.bmt.1705879

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