Nonmyeloablative stem cell transplantation in patients with ALL and AML results in low nonrelapse mortality despite high rate of infections and GVHD

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Item Type:	Article
Title:	Nonmyeloablative stem cell transplantation in patients with ALL and AML results in low nonrelapse mortality despite high rate of infections and GVHD
Creators Name:	Massenkeil, G., Nagy, M., Le Coutre, P., Heine, F., Rosen, O., Doerken, B. and Arnold, R.
Abstract:	28 patients with high-risk acute lymphoblastic (ALL) or acute myelogenous leukemia (AML) underwent nonmyeloablative stem cell transplantation (NST) from HLA-identical donors because of one or several contraindications against myeloablative conditioning. Out of 28 patients, nine (32%) hadpulmonary or hepatosplenic infiltrates due to invasive fungal infections (IFI) before NST. Out of a total of 28 patients, 17 (61%) haduncontrolledleukemia before NST. Conditioning was performed with fludarabine 180mg/m 2 , busulfan 8mg/kg and antithymocyte globulin 40mg/kg. After NST, fever of unknown origin, sepsis or pneumonia developedin 18/28 patients (64%) overall. IFI reactivatedin 3/9 patients after NST. Out of, 28 patients, 13 (46%) had late onset of acute graft-versus-host disease (GvHD), which developed at a median of 83 days after NST. GvHD frequently developed after donor lymphocyte infusions. After a median follow-up of 8 months (2–46 months), 14/28 patients (50%) have died from relapse and1/28 patients (4%) has diedfrom sepsis. Among 28 patients, 13 (46%) are alive in complete remission (CR). Six of 17 patients (35%) with uncontrolled disease and7/11 patients (63%) with CR before NST are alive in CR. Probability of overall survival at 2 years is 38%. In summary, NST offers a therapeutic alternative to patients with high-risk ALL or AML, who have contraindications against conventional high-dose conditioning. Low NRM was encountered despite high morbidity, but relapse rate was high. Therefore, controlled studies are necessary to elucidate the place of NST in the therapy of high-risk acute leukemias.
Keywords:	Nonmyeloablative Stem Cell Transplantation, ALL, AML, GvHD, Invasive Fungal Infection, Nonrelapse Mortality
Source:	Hematology Journal
ISSN:	1466-4860
Volume:	5
Number:	5
Page Range:	395-402
Date:	1 January 2004
Official Publication:	https://doi.org/10.1038/sj.thj.6200543
PubMed:	View item in PubMed

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