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Reduced Intensity Conditioning

Reduced-intensity conditioning with busulfan and fludarabine with or without antithymocyte globulin in HLA-identical sibling transplantation – a retrospective analysis

Bone Marrow Transplantation volume 33, pages 483–490 (2004)Cite this article

Summary:

It is unknown whether the addition of antithymocyte globulin (ATG) to reduced-intensity conditioning with busulfan (BU) and fludarabine (FLU) is beneficial in HLA-identical sibling transplantation. Therefore, we analyzed retrospectively data on 83 patients, who received peripheral blood stem cells from HLA-identical siblings after conditioning with either 8 mg/kg BU and 150 mg/m2 FLU (n=45) or 8 mg/kg BU, 180 mg/m2 FLU and 40 mg/kg ATG (n=38). Graft-versus-host disease (GVHD) prophylaxis consisted of CSA alone (n=32) or a combination with either MTX or MMF (n=51). The median age was 52 years. Graft failure occurred in two patients after BU/FLU and in three after BU/FLU/ATG (P=0.66). After conditioning with BU/FLU, platelet recovery was significantly faster (P=0.017), and less platelet (P<0.001) and red blood cell (P=0.002) support was needed. Incidences of acute GVHD grades II and IV were 46 and 49%, respectively. Limited chronic GVHD occurred more often after BU/FLU compared to BU/FLU/ATG (54 vs 23%, P=0.02). The overall survival, non-relapse and relapse mortality did not differ significantly. We conclude that in peripheral blood stem cell transplantation from HLA-identical siblings after reduced-intensity conditioning with BU and FLU, ATG has no major impact on the rate of graft rejection and acute GVHD, but it reduces the incidence of limited chronic GVHD.

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Acknowledgements

We thank Catrin Theuser, Silke Freund, Karin Davis and Dr Ludwig Kraut for data management. The study was supported by the Kompetenznetz ‘Akute und chronische Leukämien’.

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Authors and Affiliations

  1. Charité Campus Virchow Klinikum, Humboldt-Universität zu Berlin, Klinik für Innere Medizin m.S. Hämatologie und Onkologie, Berlin

    J Schetelig & T K Held

  2. Universitätsklinikum Carl Gustav Carus, Medizinische Klinik und Poliklinik I, Dresden

    M Bornhäuser, C Thiede & G Ehninger

  3. Klinik für Knochenmarktransplantation und Hämatologie/Onkologie GmbH, Idar-Oberstein

    M Kiehl & A A Fauser

  4. Stiftung Deutsche Klinik für Diagnostik GmbH, Zentrum für Blutstammzell- und Knochenmarktransplantation, Wiesbaden

    R Schwerdtfeger

  5. Universitäts-Krankenhaus Eppendorf, Medizinische Klinik, Einrichtung für Knochenmarktransplantation, Hamburg

    N Kröger, T Zabelina & A Zander

  6. Universitätsklinik Essen, Klinik für Knochenmarkstransplantation,

    V Runde & D Beelen

  7. Charité Campus Mitte, Humboldt-Universität zu Berlin, Medizinische Klinik II m.S. Onkologie und Hämatologie, Berlin

    W Siegert

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  1. J Schetelig
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  2. M Bornhäuser
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  6. V Runde
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  7. T Zabelina
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  8. T K Held
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  9. C Thiede
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  10. A A Fauser
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  11. D Beelen
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  13. G Ehninger
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for the Cooperative German Transplant Study Group

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Correspondence to W Siegert.

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Schetelig, J., Bornhäuser, M., Kiehl, M. et al. Reduced-intensity conditioning with busulfan and fludarabine with or without antithymocyte globulin in HLA-identical sibling transplantation – a retrospective analysis. Bone Marrow Transplant 33, 483–490 (2004). https://doi.org/10.1038/sj.bmt.1704384

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