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Graft Source

Bone marrow graft as a source of allogeneic hematopoietic stem cells in patients undergoing a reduced intensity conditioning regimen

Bone Marrow Transplantation volume 49, pages 1492–1497 (2014)Cite this article

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Abstract

In an attempt to reduce the incidence of chronic GVHD (cGVHD) after reduced-intensity conditioning (RIC), we used BM instead of PBSC and added melphalan 100 mg/m2 to the classical association of fludarabine, 30 mg/m2/day for 3 days and TBI, 200 cGy (FLUIM regimen). Between 2000 and 2012, 51 patients received BM with the FLUIM regimen (group A), and 124 received BM (n=22) or PBSC (n=102) with another RIC regimen (group B). Donors were siblings (n=123) or HLA-matched 10/10 unrelated (n=52). Full donor-type chimerism at day 100 was more often recorded in group A (86%) than in group B (62%); P<0.001. There was no difference between the two groups in terms of OS and EFS, acute GVHD, relapse and non-relapse mortality incidence. cGVHD occurred more often in group B (41%) than in group A (23%); P=0.021. In multivariate analysis, the two risk factors associated with the development of cGVHD were conditioning in group B (hazard ratio (HR)=2.871, 95% confidence interval (CI) (1.372–6.006); P=0.005) and CD34+ count (HR=1.009, 95% CI (1.006–1.011); P<0.001). In conclusion, the FLUIM regimen followed by BM leads to more frequent full-donor chimerism and a reduced incidence of cGVHD without compromising relapse and survival.

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Acknowledgements

We would like to thank all of the team members and nursing staff for providing our patients with high-quality care. We are also grateful to the association Capucine for their help in our research.

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Authors and Affiliations

  1. Unité de Greffe de Cellules Souches Hématopoïétiques, Service des Maladies du Sang, CHRU Lille, Lille, France

    E Gomez, R Duléry, V Coiteux, L Terriou, L Magro, J Gauthier, E de Berranger & I Yakoub-Agha

  2. Centre d’Etude et de Recherche en Informatique Médicale, Faculté de Médecine Lille 2, Lille, France

    C Langlois & A Duhamel

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Correspondence to I Yakoub-Agha.

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This study was partly presented at the European Bone Marrow Transplantation Congresses, April 2010, Vienna, Austria, and April 2011, Paris, France, and at the Société Française de Greffe de Moelle et de Thérapie Cellulaire annual meeting, September 2010, Paris, France.

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Gomez, E., Duléry, R., Langlois, C. et al. Bone marrow graft as a source of allogeneic hematopoietic stem cells in patients undergoing a reduced intensity conditioning regimen. Bone Marrow Transplant 49, 1492–1497 (2014). https://doi.org/10.1038/bmt.2014.193

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