Conditioning with 8-Gy total body irradiation and fludarabine for allogeneic hematopoietic stem cell transplantation in acute myeloid leukemia

被引:56
作者
Stelljes, M
Bornhauser, M
Kroger, M
Beyer, J
Sauerland, MC
Heinecke, A
Berning, B
Scheffold, C
Silling, G
Buchner, T
Neubauer, A
Fauser, AA
Ehninger, G
Berdel, WE
Kienast, J
机构
[1] Univ Munster, Dept Med Hematol & Oncol, D-48129 Munster, Germany
[2] Univ Dresden, Dept Hematol Oncol, Dresden, Germany
[3] Univ Marburg, Dept Med Hematol Oncol, Marburg, Germany
[4] Clin Bone Marrow Transplantat & Hematol Oncol, Idar Oberstein, Germany
[5] Univ Munster, Dept Med Informat & Biomath, Munster, Germany
关键词
D O I
10.1182/blood-2005-04-1377
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Seventy-one patients with acute myeloid leukemia (AML), most of them (63/71) considered ineligible for conventional allogeneic hematopoietic stem cell transplantation (HSCT), were enrolled into a phase 2 study on reduced-intensity myeloablative conditioning with fractionated 8-Gy total body irradiation (TBI) and fludarabine (120 Mg/m(2)). Patients received mobilized peripheral blood stem cells (n = 68) or bone marrow (n = 3) from siblings (n = 39) or unrelated donors (n = 32). Thirty-six patients received a transplant in complete remission (CR) and 35 had untreated or refractory disease (non-CR). Median patient age was 51 years (range, 20-66 years). Sustained engraftment was attained in all evaluable patients. With a median follow-up of 25.9 months (range, 3.7-61.2 months) in surviving patients, probabilities of overall survival for patients who received a transplant in CR and non-CR were 81% and 21% at 2 years, respectively. Relapse-free survival rates were 78% and 16%. The cumulative incidence of nonrelapse mortality (NRM) in CR patients was 8% at 2 years and beyond but amounted to 37% at 2 years in non-CR patients. Outcome data in this poor-risk population indicate that allogeneic HSCT from related or unrelated donors with 8-Gy TBI/fludarabine conditioning is feasible with low NRM and preserved antileukemic activity in AML patients in first or later CR.
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页码:3314 / 3321
页数:8
相关论文
共 52 条
[1]   Stem cell transplantation for secondary acute myeloid leukemia: Evaluation of transplantation as initial therapy or following induction chemotherapy [J].
Anderson, JE ;
Gooley, TA ;
Schoch, G ;
Anasetti, C ;
Bensinger, WI ;
Clift, RA ;
Hansen, JA ;
Sanders, JE ;
Storb, R ;
Appelbaum, FR .
BLOOD, 1997, 89 (07) :2578-2585
[2]   Haematopoietic cell transplantation as immunotherapy [J].
Appelbaum, FR .
NATURE, 2001, 411 (6835) :385-389
[3]   Is there a best transplant conditioning regimen for acute myeloid leukemia? [J].
Appelbaum, FR .
LEUKEMIA, 2000, 14 (03) :497-501
[4]   Total body irradiation before allogeneic bone marrow transplantation: Is more dose better? [J].
Bieri, S ;
Helg, C ;
Chapuis, B ;
Miralbell, R .
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS, 2001, 49 (04) :1071-1077
[5]   Conditioning with fludarabine and targeted busulfan for transplantation of allogeneic hematopoietic stem cells [J].
Bornhäuser, M ;
Storer, B ;
Slattery, JT ;
Appelbaum, FR ;
Deeg, HJ ;
Hansen, J ;
Martin, PJ ;
McDonald, GB ;
Nichols, WG ;
Radich, J ;
Woolfrey, A ;
Jenke, A ;
Schleyer, E ;
Thiede, C ;
Ehninger, G ;
Anasetti, C .
BLOOD, 2003, 102 (03) :820-826
[6]   Randomised comparison of addition of autologous bone-marrow transplantation to intensive chemotherapy for acute myeloid leukaemia in first remission: results of MRC AML 10 trial [J].
Burnett, AK ;
Goldstone, AH ;
Stevens, RMF ;
Hann, IM ;
Rees, JKH ;
Gray, RG ;
Wheatley, K .
LANCET, 1998, 351 (9104) :700-708
[7]   The value of allogeneic bone marrow transplant in patients with acute myeloid leukaemia at differing risk of relapse: Results of the UK MRC AML 10 trial [J].
Burnett, AK ;
Wheatley, K ;
Goldstone, AH ;
Stevens, RF ;
Hann, IM ;
Rees, JHK ;
Harrison, G .
BRITISH JOURNAL OF HAEMATOLOGY, 2002, 118 (02) :385-400
[8]   Treosulfan and fludarabine:: a new toxicity-reduced conditioning regimen for allogeneic hematopoietic stem cell transplantation [J].
Casper, J ;
Knauf, W ;
Kiefer, T ;
Wolff, D ;
Steiner, B ;
Hammer, U ;
Wegener, R ;
Kleine, HD ;
Wilhelm, S ;
Knopp, A ;
Hartung, G ;
Dölken, G ;
Freund, M .
BLOOD, 2004, 103 (02) :725-731
[9]   Chemotherapy compared with autologous or allogeneic bone marrow transplantation in the management of acute myeloid leukemia in first remission [J].
Cassileth, PA ;
Harrington, DP ;
Appelbaum, FR ;
Lazarus, HM ;
Rowe, JM ;
Paietta, E ;
Willman, C ;
Hurd, DD ;
Bennett, JM ;
Blume, KG ;
Head, DR ;
Wiernik, PH .
NEW ENGLAND JOURNAL OF MEDICINE, 1998, 339 (23) :1649-1656
[10]   A NEW METHOD OF CLASSIFYING PROGNOSTIC CO-MORBIDITY IN LONGITUDINAL-STUDIES - DEVELOPMENT AND VALIDATION [J].
CHARLSON, ME ;
POMPEI, P ;
ALES, KL ;
MACKENZIE, CR .
JOURNAL OF CHRONIC DISEASES, 1987, 40 (05) :373-383