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Non-Myeloablative Stem Cell Transplants

Rapid achievement of complete donor chimerism and low regimen-related toxicity after reduced conditioning with fludarabine, carmustine, melphalan and allogeneic transplantation

Bone Marrow Transplantation volume 26, pages 243–250 (2000)Cite this article

Abstract

between august 1998 and july 1999, 21 patients received a novel protocol of reduced conditioning with fludarabine, carmustine and melphalan (fbm) followed by matched-related allogeneic peripheral blood stem cell transplantation (pbsct) in a prospective multicenter phase i/ii study. cyclosporin a and ‘mini-methotrexate’ were used for gvhd prophylaxis. patients were included because of age, advanced disease, previous transplantation or co-morbidity. hematopoietic engraftment after allogeneic transplantation was rapid with a median white blood count (wbc) >1 × 109/l on day +11 (range 10–17) and a median platelet count >20 × 109/l on day +13 (range 9–36). Donor chimerism was complete in 16/21 (76%) patients at all time points during follow-up and mixed at least on one occasion in 5/21 (24%) patients. The conditioning regimen was well tolerated with low toxicity even in previously transplanted patients. Thirteen patients (62%) developed acute GVHD grades II–IV. Nineteen out of 21 patients achieved complete (CR, n = 15) or partial remission (PR, n = 4) with a median patient follow-up of 354+ days (range 258–577) for patients alive. The reduced intensity protocol FBM is feasible with rapid engraftment, early achievement of complete donor chimerism, low toxicity, especially in heavily pretreated patients, and good response rates in advanced disease patients. Bone Marrow Transplantation (2000) 26, 243–250.

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Acknowledgements

We are grateful to the entire transplantation team, especially to E Dengler, B Sauer, D Wider and E Samek for excellent technical assistance, I Matt for documentation work and E Lenartz for transplant coordination.

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  1. R Wäsch

    Present address: The Rockefeller University, 1230 York Avenue, New York, 10021, New York, USA

Authors and Affiliations

  1. Department of Hematology and Oncology, Albert-Ludwigs University Medical Center, Freiburg, Germany

    R Wäsch, S Reisser, H Bertz, M Engelhardt, R Kunzmann, H Veelken & J Finke

  2. Department of Hematology and Oncology, University of Regensburg, Regensburg, Germany

    J Hahn & E Holler

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Wäsch, R., Reisser, S., Hahn, J. et al. Rapid achievement of complete donor chimerism and low regimen-related toxicity after reduced conditioning with fludarabine, carmustine, melphalan and allogeneic transplantation. Bone Marrow Transplant 26, 243–250 (2000). https://doi.org/10.1038/sj.bmt.1702512

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