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Haematopoietic stem cell transplantation with non‐myeloablative conditioning in the outpatient setting: results, complications and admission requirements in a single institution
Author(s) -
Petersen Søren L.,
Madsen Hans O.,
Ryder Lars P.,
Svejgaard Arne,
Jakobsen Bodil K.,
Sengeløv Henrik,
Heilmann Carsten,
Dickmeiss Ebbe,
Vindeløv Lars L.
Publication year - 2004
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/j.1365-2141.2004.04897.x
Subject(s) - medicine , fludarabine , transplantation , total body irradiation , cohort , surgery , hematopoietic stem cell transplantation , cyclophosphamide , chemotherapy
Summary Thirty patients with haematological malignancies received peripheral blood stem cells from human leucocyte antigen (HLA)‐identical sibling donors after non‐myeloablative conditioning with fludarabine and total body irradiation. Twenty‐seven patients received the transplant as an outpatient procedure. All patients engrafted. The probability of acute graft‐ versus ‐host disease (GVHD) grades II–IV and extensive chronic GVHD was 57% and 80%, respectively. Patients alive on day +365 experienced a median of 44 d (range 4–151) of hospitalization during the first year. In the entire cohort, GVHD accounted for 22%, infections for 18%, thrombotic thrombocytopenic purpura (TTP) for 16% and engraftment syndrome for 14% of the time in hospital. The 1‐year risk of TTP was 26%. Acute GVHD was a risk factor for the development of TTP ( P = 0·008). With a median follow‐up of 602 d, the 2‐year estimates for overall survival, progression‐free survival, non‐relapse mortality and relapse related mortality were 68%, 43%, 22% and 13%, respectively. This transplantation regimen is feasible and induces long‐term remissions in heavily pretreated patients. The procedure can be performed in the outpatient setting, but complications could result in a substantial number of admissions during the first year.