This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Taussig, D.C. Articles by Barnett, M.J. Search for Related Content PubMed PubMed Citation Articles by Taussig, D.C. Articles by Barnett, M.J. Social Bookmarking                            What's this?

Durable Remissions of Myelodysplastic Syndrome and Acute Myeloid Leukemia After Reduced-Intensity Allografting

D.C. Taussig, A.J. Davies, J.D. Cavenagh, H. Oakervee, D. Syndercombe-Court, S. Kelsey, J.A.L. Amess, A.Z.S. Rohatiner, T.A. Lister, M.J. Barnett

From the Division of Haematological Oncology, St Bartholomew’s Hospital, London, United Kingdom.

Address reprint requests to Michael Barnett, BM, Department of Medical Oncology, 45 Little Britain, St Bartholomew’s Hospital, London EC1A 7BE, United Kingdom; email: Michael.Barnett{at}cancer.org.uk.

Purpose: To evaluate the use of reduced-intensity (RI) conditioning with allogeneic hematopoietic stem cell transplantation (HSCT) from HLA-identical family donors in patients with myelodysplastic syndrome (MDS) or acute myeloid leukemia (AML).

Patients and Methods: Sixteen patients (median age, 54 years; range, 37 to 66 years) underwent RI-HSCT using a conditioning regimen of fludarabine 25 mg/m² daily for 5 days and either cyclophosphamide 1 g/m² daily for 2 days (14 patients) or melphalan 140 mg/m² for 1 day (two patients). The median number of CD34⁺ cells and CD3⁺ cells infused per kilogram of recipient weight was 4.5 x 10⁶ (range, 1.8 to 7.3 x 10⁶ cells) and 2.9 x 10⁸ (range, 0.1 to 9.6 x 10⁸ cells), respectively.

Results: There was no transplant-related mortality (TRM) within 100 days of HSCT. Grade 1 to 2 acute graft-versus-host disease (GVHD) occurred in three patients, but neither grade 3 nor grade 4 disease was observed. Chronic GVHD occurred in 10 patients. One patient had cytomegalovirus (CMV) reactivation but did not develop CMV disease. With a median follow-up of 26 months (range, 15 to 45 months), 11 patients are alive (nine in continuous complete remission and one in complete remission after a second transplantation), and five have died (four from disease progression and one from bone-marrow aplasia induced by cyclosporine withdrawal). The 2-year actuarial overall and event-free survival rates were 69% (95% confidence interval [CI], 40% to 86%) and 56% (95% CI, 30% to 68%), respectively.

Conclusion: This strategy of RI-HSCT resulted in reliable engraftment with low incidence of acute GVHD and TRM. Durable remissions were observed in patients with MDS and AML consistent with a graft-versus-leukemia effect.

Supported by Cancer Research UK.

Presented in part at the American Society of Hematology annual meeting, Philadelphia, PA, December 2002.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				C. Schmid, M. Schleuning, R. Schwerdtfeger, B. Hertenstein, E. Mischak-Weissinger, D. Bunjes, S. v. Harsdorf, C. Scheid, U. Holtick, H. Greinix, et al. Long-term survival in refractory acute myeloid leukemia after sequential treatment with chemotherapy and reduced-intensity conditioning for allogeneic stem cell transplantation Blood, August 1, 2006; 108(3): 1092 - 1099. [Abstract] [Full Text] [PDF]

				J. K. Davies, D. C. Taussig, H. Oakervee, A. J. Davies, S. G. Agrawal, J. G. Gribben, T. A. Lister, and J. D. Cavenagh Long-Term Follow-Up After Reduced-Intensity Conditioning Allogeneic Transplantation for Acute Myeloid Leukemia/Myelodysplastic Syndrome: Late CNS Relapses Despite Graft-Versus-Host Disease J. Clin. Oncol., May 10, 2006; 24(14): e23 - e25. [Full Text] [PDF]

				S. Tauro, C. Craddock, K. Peggs, G. Begum, P. Mahendra, G. Cook, J. Marsh, D. Milligan, A. Goldstone, A. Hunter, et al. Allogeneic Stem-Cell Transplantation Using a Reduced-Intensity Conditioning Regimen Has the Capacity to Produce Durable Remissions and Long-Term Disease-Free Survival in Patients With High-Risk Acute Myeloid Leukemia and Myelodysplasia J. Clin. Oncol., December 20, 2005; 23(36): 9387 - 9393. [Abstract] [Full Text] [PDF]

				C. Crawley, R. Szydlo, M. Lalancette, A. Bacigalupo, A. Lange, M. Brune, G. Juliusson, A. Nagler, A. Gratwohl, J. Passweg, et al. Outcomes of reduced-intensity transplantation for chronic myeloid leukemia: an analysis of prognostic factors from the Chronic Leukemia Working Party of the EBMT Blood, November 1, 2005; 106(9): 2969 - 2976. [Abstract] [Full Text] [PDF]

				E. Jourdan, J.-M. Boiron, N. Dastugue, N. Vey, G. Marit, F. Rigal-Huguet, L. Molina, N. Fegueux, A. Pigneux, C. Recher, et al. Early Allogeneic Stem-Cell Transplantation for Young Adults With Acute Myeloblastic Leukemia in First Complete Remission: An Intent-to-Treat Long-Term Analysis of the BGMT Experience J. Clin. Oncol., October 20, 2005; 23(30): 7676 - 7684. [Abstract] [Full Text] [PDF]

				C. Schmid, M. Schleuning, G. Ledderose, J. Tischer, and H.-J. Kolb Sequential Regimen of Chemotherapy, Reduced-Intensity Conditioning for Allogeneic Stem-Cell Transplantation, and Prophylactic Donor Lymphocyte Transfusion in High-Risk Acute Myeloid Leukemia and Myelodysplastic Syndrome J. Clin. Oncol., August 20, 2005; 23(24): 5675 - 5687. [Abstract] [Full Text] [PDF]

				A. Y. L. Ho, A. Pagliuca, M. Kenyon, J. E. Parker, A. Mijovic, S. Devereux, and G. J. Mufti Reduced-intensity allogeneic hematopoietic stem cell transplantation for myelodysplastic syndrome and acute myeloid leukemia with multilineage dysplasia using fludarabine, busulphan, and alemtuzumab (FBC) conditioning Blood, September 15, 2004; 104(6): 1616 - 1623. [Abstract] [Full Text] [PDF]