Unrelated or mismatched related donor stem cell transplantation for myeloid malignancies with a fludarabine- and busulfan-based reduced-intensity conditioning regimen

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Many patients with myeloid malignancies are ineligible for conventional allogeneic hematopoietic stem cell transplantation (allo-HSCT) with myeloablative conditioning because of their age, medical problems, or the lack of a suitable HLA-identical related donor. The outcome of 9 patients with myeloid malignancies who underwent allo-HSCT following fludarabine- and busulfan- based reduced intensity conditioning (RIC) from unrelated or mismatched related donor is herein described. Six patients received bone marrow from an unrelated donor, two received a serologically mismatched related allograft, and one received serologically mismatched unrelated cord blood. All patients demonstrated successfully engraftment at a median of 15 days and showed complete donor chimerism of 9527772566420n day 28. One patient developed grade 3 regimen-related toxicity. Grade II to IV acute graft-versus-host disease (GVHD) and extensive type chronic GVHD developed in 6 and 4 patients, respectively. Of the two patients who received the second HSCT, one died of relapse and one died of acute GVHD. The remaining 7 patients are currently alive in remission. The overall survival at 4 years after allo-HSCT was 77.8%.0 These observations suggest that these RIC regimens enable rapid engraftment of stem cells from alternative donors with tolerable toxicities in patients who are not eligible for conventional HSCT.
2008-06-01