J Korean Med Sci.  2007 Apr;22(2):227-234. 10.3346/jkms.2007.22.2.227.

Allogeneic Stem Cell Transplantation for Patients with Advanced Hematological Malignancies: Comparison of Fludarabine-based Reduced Intensity Conditioning versus Myeloablative Conditioning

• Kim I
• Lee KH
• Choi Y
• Keam B
• Koo NH
• Yoon SS
• Yoo KY
• Park S
• Kim BK

• KMID: 1713172
• DOI: http://doi.org/10.3346/jkms.2007.22.2.227

Abstract

We compared the outcomes of allogeneic hematopoietic stem cell transplantation using reduced intensity and myeloablative conditioning for the treatment of patients with advanced hematological malignancies. A total of 75 adult patients received transplants from human leukocyte antigen-matched donors, coupled with either reduced intensity (n=40; fludarabine/melphalan, 28; fludarabine/cyclophosphamide, 12) or myeloablative conditioning (n=35, busufan/cyclophosphamide). The patients receiving reduced intensity conditioning were elderly, or exhibited contraindications for myeloablative conditioning. Neutrophil and platelet engraftment occurred more rapidly in the reduced intensity group (median, 9 days vs. 18 days in the myeloablative group, p<0.0001; median 12 days vs. 22 days in the myeloablative group, p=0.0001, respectively). Acute graft-versus-host disease (> or =grade II) occurred at comparable frequencies in both groups, while the incidence of hepatic veno-occlusive disease was lower in the reduced intensity group (3% vs. 20% in the myeloablative group, p=0.02). The overall 1-yr survival rates of the reduced intensity and myeloablative group patients were 44% and 15%, respectively (p=0.16). The results of present study indicate that patients with advanced hematological malignancies, even the elderly and those with major organ dysfunctions, might benefit from reduced intensity transplantation.

Keyword

Allogeneic Stem Cell Transplantation; Advanced Hematological Malignancy; Reduced Intensity Conditioning

MeSH Terms

Vidarabine/administration & dosage/*analogs & derivatives
Treatment Outcome
Transplantation, Homologous/methods
Transplantation Conditioning/*methods
Myeloablative Agonists/*administration & dosage
Middle Aged
Male
International Cooperation
Humans
Hematopoietic Stem Cell Transplantation/*methods
Hematologic Neoplasms/*therapy
Female
Busulfan/*administration & dosage
Aged
Adult
Adolescent

Figure

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  Fig. 1 Cumulative incidences of nonrelapse mortality of patents with advanced hematological malignancies treated by reduced intensity and myeloablative conditionings.

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  Fig. 2 Overall survivals for patients with advanced hematological malignancies after reduced intensity and myeloablative transplantations.

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  Fig. 3 Progression free survivals for patients with advanced hematological malignancies after reduced intensity and myeloablative transplantations.

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