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Conditioning Regimens

Reduced-intensity conditioning using fludarabine with either antithymocyte globulin and BU, or low-dose TBI allowing allogeneic hematopoietic SCT

Bone Marrow Transplantation volume 45, pages 31–37 (2010)Cite this article

Abstract

In a single-center study, we analyzed the outcomes of 66 patients with advanced hematological malignancies receiving two reduced-intensity conditioning regimens for allogeneic transplantation: fludarabine and low-dose TBI (flu/TBI, n=25), or fludarabine, antithymocyte globulin and BU (flu/ATG/BU, n=41). The selection criteria were based on the hypothesis that flu/TBI patients were expected to achieve autologous recovery in the event of non-engraftment. Sixty-three patients (95%) engrafted. Regimen-related mortality at day 100 and 1 year was 6 and 15%, respectively. With median follow-up of 50.4 months, survival did not differ by regimen. Multivariate analysis confirmed that the type of regimen did not affect relapse. In patients achieving full donor chimerism by day 30, those conditioned with flu/TBI showed greater overall survival (P=0.02). Engraftment failure occurred in two patients (3%), both of whom received flu/TBI. We conclude that conditioning with flu/TBI or flu/ATG/BU yields comparable survival and remission outcomes. By contrast to our hypothesis, patients receiving flu/TBI who subsequently failed engraftment did not achieve autologous recovery. Yet, rapid attainment of full donor chimerism after flu/TBI is associated with greater survival than after flu/ATG/BU. Further, larger prospective randomized studies are required to define the advantage of one regimen over the other.

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Acknowledgements

We are grateful to Christine Nejame and to the nurses and support staff of the Shands Bone Marrow Transplant Unit for dedicated patient care.

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Author notes

  1. C Cable and M P Buzzeo: These authors contributed equally to this work.

Authors and Affiliations

  1. Division of Hematology/Oncology, Department of Medicine, University of Florida, Gainesville, FL, USA

    C Cable, S Khan, H Leather, J Moreb, K Jamieson, J R Wingard & V Reddy

  2. University of South Florida College of Medicine, Tampa, FL, USA

    M P Buzzeo

  3. Division of Nephrology, Department of Medicine, Hypertension and Transplantation, University of Florida, Gainesville, FL, USA

    J D Schold

  4. Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, FL, USA

    J Scornik

  5. Department of Radiation Oncology, University of Florida, Gainesville, FL, USA

    R J Amdur

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  1. C Cable
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  2. M P Buzzeo
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  11. V Reddy
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Correspondence to V Reddy.

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Cable, C., Buzzeo, M., Schold, J. et al. Reduced-intensity conditioning using fludarabine with either antithymocyte globulin and BU, or low-dose TBI allowing allogeneic hematopoietic SCT. Bone Marrow Transplant 45, 31–37 (2010). https://doi.org/10.1038/bmt.2009.126

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