Hematopoietic cell transplant outcomes after myeloablative conditioning with fludarabine,busulfan, low-dose total body irradiation,and rabbit antithymocyte globulin |
| |
Authors: | Samar Ousia Amit Kalra Tyler S Williamson Nicole Prokopishyn Poonam Dharmani-Khan Faisal M Khan Victor Jimenez-Zepeda Kareem Jamani Peter R Duggan Andrew Daly James A Russell Jan Storek |
| |
Institution: | 1. University of Calgary, Calgary, AB, Canada
Alberta Blood and Marrow Transplant Program, Alberta Health Services, Calgary, AB, Canada
Ain Shams University, Cairo, Egypt;2. University of Calgary, Calgary, AB, Canada;3. University of Calgary, Calgary, AB, Canada
Alberta Blood and Marrow Transplant Program, Alberta Health Services, Calgary, AB, Canada |
| |
Abstract: | Optimal conditioning and graft-vs-host disease (GVHD) prophylaxis for hematopoietic cell transplantation (HCT) are unknown. Here, we report on outcomes after low toxicity, myeloablative conditioning consisting of fludarabine, busulfan, and 4 Gy total body irradiation, in combination with thymoglobulin and post-transplant methotrexate and cyclosporine. We retrospectively studied 700 patients with hematologic malignancies who received blood stem cells from 7 to 8/8 HLA-matched unrelated or related donors. Median follow-up of surviving patients was 5 years. At 5 years, overall survival (OS), relapse-free survival (RFS), and chronic GVHD/relapse-free survival (cGRFS) were 58%, 55%, and 40%. Risk factors for poor OS, RFS, and cGRFS were (1). high to very high disease risk index (DRI), (2). high recipient age, and (3). cytomegalovirus (CMV)-seropositive recipient with seronegative donor (D?R+). The latter risk factor applied particularly to patients with lymphoid malignancies. Neither donor other than HLA-matched sibling (7-8/8 unrelated) nor one HLA allele mismatch was risk factors for poor OS, RFS, or cGRFS. In conclusion, the above regimen results in excellent long-term outcomes. The outcomes are negatively impacted by older age, high or very high DRI, and CMV D?R+ serostatus, but not by donor unrelatedness or one HLA allele mismatch. |
| |
Keywords: | conditioning myeloablative outcomes stem cell transplant |
|
|