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Last Updated: 2001-08-06 11:21:17 EDT (Reuters Health)
WESTPORT, CT (Reuters Health) – Allogeneic hematopoietic stem-cell transplantation (HSCT) after nonmyeloablative preparative regimens offers hope for some patients with malignancies, according to a report in the July 15th Journal of Clinical Oncology.
Allogeneic HSCT is effective for a wide range of disorders, the authors explain, but its use is limited by the high mortality and morbidity related to the myeloablative conditioning regimens.
Dr. Jean-Michel Boiron, from Centre Hospitalo-Universitaire de Bordeaux in Pessac, France, and colleagues determined the impact of various pre- and post-transplantation factors on the outcomes of 92 patients undergoing allogeneic HSCT after nonmyeloablative preparative regimens.
Seventy-nine (92%) of 86 assessable patients engrafted, the authors report, with higher engraftment rates among patients receiving bone marrow instead of peripheral blood precursor cells and among those who had received transplants previously.
Half the patients developed acute graft-versus-host disease (GVHD) by 3 months post-transplant. After the procedure, 52 patients achieved complete remission and 12 achieved partial remission. Overall survival at 18 months post-transplantation was 32%, the results indicate, and transplant-related mortality was 38%.
Three factors significantly influenced overall survival, the investigators say. Patients with pretransplantation diagnoses of lymphoma, myeloma, or chronic myelogenous leukemia fared better than others, as did patients in complete remission at the time of transplant. Moreover, the duration of GVHD prophylaxis correlated with overall survival.
"Given our observations," the authors conclude, "the strategy of allogeneic transplantation after nonmyeloablative conditioning could be proposed preferentially to patients who meet the following conditions: (1) have either lymphomas, CML, or myeloma; (2) are in response after conventional therapy; (3) receive a large number of CD34+ (selected) cells; (4) are treated after a regimen containing fludarabine and a long GVHD prophylaxis followed by prophylactic and preemptive donor lymphocyte infusion; (5) have documented chimerism and minimal residual disease."
"The optimum program for each disease, the best hematopoietic stem-cell source, GVHD prophylaxis adjustment, and donor-recipient pairing have yet to be defined," they caution.
J Clin Oncol 2001;19:3340-3349.
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