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Conditioning Regimens

Safety and outcome after fludarabine–thiotepa–TBI conditioning for allogeneic transplantation: a prospective study of 30 patients with hematologic malignancies

Bone Marrow Transplantation volume 32, pages 9–13 (2003)Cite this article

Summary:

Fludarabine, thiotepa and total body irradiation (TBI) has been used as conditioning in haplo-identical transplantation. We studied this conditioning regimen in adults undergoing matched sibling transplantation and alternative donor transplantation. A total of 30 consecutive patients underwent matched related, haplo-identical related or matched unrelated donor transplantation with fludarabine, thiotepa and TBI conditioning. All but four had advanced hematologic malignancies. For haplo-identical transplant, ATG was added to the regimen. All patients received peripheral blood stem cells; these were T-cell depleted for 2-antigen or 3-antigen mismatched related transplantation. Additional graft-versus-host disease prophylaxis consisted of tacrolimus and mini-methotrexate. One recipient of haplo-identical transplant failed to engraft; all other evaluable patients had prompt engraftment. Four patients died of regimen-related toxicity. In all, 14 additional patients died of regimen-related causes including four from failure to thrive with persistent thrombocytopenia and four from delayed pulmonary toxicity. Six patients relapsed. Progression-free survival at 12 months was 47% (90% CI: 25–69%) for recipients of HLA-identical sibling transplants and 30% (90% CI: 14–46%) for all patients. Five of six long-term survivors have extensive chronic GVHD. As a result of the delayed complications and a relatively high recurrence rate, we abandoned this regimen.

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Authors and Affiliations

  1. University of Illinois at Chicago, Chicago, IL, USA

    K van Besien, S Devine, A Wickrema, E Jessop, K Amin, M Yassine, V Maynard, W Stock, D Peace, F Ravandi, Y-H Chen, T Cheung, S Vijayakumar, R Hoffman & J Sosman

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  1. K van Besien
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  2. S Devine
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  3. A Wickrema
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  4. E Jessop
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  5. K Amin
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  7. V Maynard
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  8. W Stock
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  9. D Peace
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  10. F Ravandi
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  13. S Vijayakumar
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  14. R Hoffman
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  15. J Sosman
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Supported in part by a grant from Berlex pharmaceuticals

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van Besien, K., Devine, S., Wickrema, A. et al. Safety and outcome after fludarabine–thiotepa–TBI conditioning for allogeneic transplantation: a prospective study of 30 patients with hematologic malignancies. Bone Marrow Transplant 32, 9–13 (2003). https://doi.org/10.1038/sj.bmt.1704088

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  • DOI: https://doi.org/10.1038/sj.bmt.1704088

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