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Favourable outcome for patients with myeloid disorders treated with fludarabine–melphalan reduced‐intensity conditioning and allogeneic bone marrow stem cell transplantation without the use of T‐lymphocyte‐depleting antibodies
Author(s) -
Malladi R. K.,
Peniket A. J.,
Norton A. E.,
Campbell A. J.,
Collins G. P.,
Samol J.,
Eagleton H.,
Miller E.,
Morgenstern G.,
Jones J.,
KeenMcguire A.,
Barnardo M.,
Littlewood T. J.
Publication year - 2004
Publication title -
european journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 84
eISSN - 1600-0609
pISSN - 0902-4441
DOI - 10.1111/j.1600-0609.2004.00266.x
Subject(s) - fludarabine , medicine , melphalan , transplantation , myeloid , bone marrow , hematopoietic stem cell transplantation , oncology , donor lymphocyte infusion , surgery , gastroenterology , immunology , chemotherapy , cyclophosphamide
We report the use of reduced‐intensity conditioning (RIC)‐matched sibling allogeneic bone marrow stem cell transplantation as a method of establishing a graft‐vs.‐leukaemia (GvL) effect against myeloid disorders using a fludarabine–melphalan protocol without the use of T‐lymphocyte‐depleting antibodies. The 16 patients in this group had predominantly poor‐risk acute myeloid leukaemia (AML) ( n = 10), AML/myelodysplasia (MDS) ( n = 2) and MDS ( n = 4). All but one patient achieved full haematopoietic engraftment. Thirteen of 16 patients are alive and in continued complete remission on completion of this study with a median follow‐up of 426 d (range 83–1524). The actuarial 4 yr disease‐free and overall survival is 79% for both. Only one patient relapsed following transplant, giving a relapse rate of 6% during the study period. The treatment‐related mortality was 13% ( n = 2). Overall, acute graft‐vs.‐host disease (GvHD) occurred in 53% (8/15), with acute GvHD grade II or above occurring in 47% (7/15). In the 13 evaluable patients, chronic GvHD occurred in 46% (6/13), with this being extensive in three patients. These results suggest that a GvL effect can be delivered against poor‐risk myeloid disorders with a low non‐relapse mortality using this fludarabine–melphalan RIC protocol.