Allogeneic peripheral blood stem cell transplantation with reduced-intensity conditioning:: results of a prospective multicentre study

被引:95
作者
Martino, R
Caballero, MD
Canals, C
Simón, JAP
Solano, C
Urbano-Ispízua, A
Bargay, J
Rayón, C
Léon, A
Sarrá, J
Odriozola, J
Conde, JG
Sierra, J
San Miguel, J
机构
[1] Hosp Santa Creu & Sant Pau, Serv Hematol Clin, Barcelona 08025, Spain
[2] Hosp Univ Salamanca, Serv Hematol, Salamanca, Spain
[3] Hosp Clin & Univ Valencia, Serv Hematol, Valencia, Spain
[4] Hosp Clin Barcelona, Serv Hematol, Barcelona, Spain
[5] Hosp Son Dureta, Serv Hematol, Palma de Mallorca, Spain
[6] Hosp Covadonga, Serv Hematol, Oviedo, Spain
[7] Hosp SAS Jerez de la Frontera, Jerez Del La Frontera, Spain
[8] Inst Catala Oncol, Lhospitalet De Llobregat, Spain
[9] Hosp Ramon y Cajal, E-28034 Madrid, Spain
关键词
reduced-intensity; allogeneic; transplantation;
D O I
10.1046/j.1365-2141.2001.03153.x
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Reduced-intensity conditioning (RIC) regimens for allogeneic. haematopoietic stem cell transplantation (SCT) have been shown to lead to engraftment of donor stem cells without the severe extra-haematological toxicities of traditional myeloablative transplants. Between December 1998 and December 2000, 76 patients underwent a RIC peripheral blood SCT in a prospective multicentre study. The median age was 53 years, and 57 patients were beyond the early phase of their disease. The conditioning regimens consisted of fludarabine (150 mg/ m(2)) plus melphalan (140 mg/m(2)) or busulphan (10 mg/kg). Graft-versus-host disease (GVHD) prophylaxis consisted of cyclosporin A plus short-course methotrexate. The preparative regimens were well tolerated. All patients experienced severe pancytopenia, but haematological recovery was prompt in all but two cases (early deaths). The 100-d probability of developing grade II-IV acute GVHD was 32% (10% grade III-IV), and the 1-year probability of developing chronic extensive GVHD was 43%. Early complete donor chimaerism was observed in 52/68 patients, and 16 evaluable patients were in complete chimaerism 1 year post transplant. With a median follow-up of 283 d (355 in 48 survivors), the 1-year probability of transplant-related mortality was 20%, and the 1-year overall and progression-free survivals were 60% and 55% respectively. In conclusion, RIC regimens lead to low early toxicity after allografting, with stable donor haematopoietic engraftment, with an apparent low risk of acute GVHD. Chronic GVHD, however, develops in a significant proportion of patients.
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收藏
页码:653 / 659
页数:7
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