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Allografting

Reduced-intensity conditioning for allogeneic hematopoietic stem cell transplantation with fludarabine and melphalan is associated with durable disease control in myelodysplastic syndrome

Bone Marrow Transplantation volume 40, pages 843–850 (2007)Cite this article

Abstract

We retrospectively evaluated the outcome of reduced-intensity conditioning (RIC) followed by allogeneic hematopoietic stem cell transplantation (HCT) in 43 patients with myelodysplastic syndrome (MDS) or AML arising from MDS. All patients received fludarabine plus melphalan followed by an allogeneic HCT from an HLA-identical sibling (SIB: n=19) or unrelated donor (MUD: n=24). Median age was 58 years (range: 30–71). Diagnoses at transplantation were RA (n=8), RARS (n=1), RAEB (n=13), RAEB-T (n=6), or AML arising from MDS (n=15). Of 28 patients with MDS, two patients had low, 10 had intermediate-1, nine had intermediate-2 and seven had high-risk MDS by IPSS criteria. All patients initially engrafted with the median neutrophil recovery of 15 days (range: 9–27). The 2-year overall survival, disease-free survival, relapse and transplant-related mortality were 53.5% (CI 45.2–61.1), 51.2% (CI 43.3–58.5), 16.3% (CI 7.9–30.7) and 35.2% (26.4–45.7), respectively. Grade II–IV acute graft-versus-host disease occurred in 27 (63%) patients. There was no significant survival difference between SIB and MUD-HCT, but the relapse rate was higher among SIB donor recipients when compared to MUD (38.5 versus 7%, P=0.02). RIC with fludarabine plus melphalan was associated with durable disease control and acceptable toxicity in this high-risk cohort.

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Acknowledgements

We acknowledge our transplant coordinators and transplant nurses for their dedicated care of our patients, and all the members of the Bone Marrow Transplant Team for their constant support of the program. We also thank clinical research associates for their support on data management and collections.

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Authors and Affiliations

  1. Division of Hematology/Hematopoietic Cell Transplantation, City of Hope Comprehensive Cancer Center, Duarte, CA, USA

    R Nakamura, R Rodriguez, A Stein, A Naing, R Bhatia, V Pullarkat, M Kirschbaum, S J Forman & M R O'Donnell

  2. Department of Biostatistics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA

    J Palmer & N Tsai

  3. Division of Pathology, City of Hope Comprehensive Cancer Center, Duarte, CA, USA

    K Chang & M L Slovak

  4. The City of Hope-Southern California Kaiser Permanente Bone Marrow Transplant Program, Duarte, CA, USA

    R Spielberger & N Kogut

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  1. R Nakamura
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Correspondence to R Nakamura.

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Nakamura, R., Rodriguez, R., Palmer, J. et al. Reduced-intensity conditioning for allogeneic hematopoietic stem cell transplantation with fludarabine and melphalan is associated with durable disease control in myelodysplastic syndrome. Bone Marrow Transplant 40, 843–850 (2007). https://doi.org/10.1038/sj.bmt.1705801

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  • DOI: https://doi.org/10.1038/sj.bmt.1705801

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