Reduced-Intensity Conditioning Allogeneic Hematopoietic Cell Transplantation for Patients with Hematologic Malignancies Who Relapse following Autologous Transplantation: A Multi-institutional Prospective Study from the Cancer and Leukemia Group B (CALGB trial 100002)

Asad Bashey, Kouros Owzar, Jeffrey L. Johnson, Peggy S. Edwards, Michael Kelly, Lee Ann Baxter-Lowe, Steven Devine, Sherif Farag, David Hurd, Edward Ball, Philip McCarthy, John Lister, Thomas C. Shea, Charles Linker

Research output: Contribution to journalArticle

7 Scopus citations

Abstract

We prospectively treated 80 patients with relapse of malignancy or secondary myelodysplasia after autologous hematopoietic cell transplantation (AHCT) with allogeneic HCT (allo-HCT) using a reduced-intensity conditioning regimen of fludarabine 150 mg/m2 plus intravenous busulfan 6.4 mg/kg. Both matched sibling (MSD) and unrelated donors (MUD) were allowed. Patients transplanted from MUD donors received more intensive graft-versus-host disease (GVHD) prophylaxis, including rabbit antithymocyte globulin (ATG) 10 mg/kg, mycophenolate mofetil, and an extended schedule of tacrolimus. With a median follow-up of 3.1 years (0.9-5.8), treatment-related mortality (TRM) at 6 months and 2 years was 8% and 23%, respectively. Neither TRM nor the rates of acute GVHD (aGVHD) were different in those with sibling or MUD donors. Donor CD3 cell chimerism >90% at day +30 was achieved more often in patients with MUD than with matched sibling donors, 70% versus 23% (P < .0001). Median event-free suvival was higher in patients who achieved early full donor chimerism (14.2 versus 8 months, P = .0395). Allo-HCT using this reduced-intensity conditioning regimen can be performed with low TRM in patients who have received a prior AHCT. Efforts to improve early donor CD3 chimerism may improve event-free survival.

Original languageEnglish (US)
Pages (from-to)558-565
Number of pages8
JournalBiology of Blood and Marrow Transplantation
Volume17
Issue number4
DOIs
StatePublished - Apr 1 2011
Externally publishedYes

Keywords

  • Allogeneic
  • Autologous
  • Reduced-intensity conditioning
  • Relapse
  • Second transplant

ASJC Scopus subject areas

  • Hematology
  • Transplantation

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