Feasibility of salvage cord blood transplantation using a fludarabine, melphalan, and low-dose anti-thymocyte globulin conditioning regimen View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2019-04

AUTHORS

Takumi Hoshino, Satoru Takada, Nahoko Hatsumi, Toru Sakura

ABSTRACT

Primary graft failure (PGF) is a lethal complication that occurs early after allogeneic stem cell transplantation (allo-SCT). Cord blood transplantation (CBT) is a potential re-transplantation option. Total body irradiation (TBI) is often incorporated into the pre-salvage CBT conditioning regimen following PGF; however, patients experiencing PGF are not always amenable to TBI, and non-TBI regimens for salvage CBT should be established. Here, we report five patients with hematologic malignancies who received salvage CBT for PGF following a non-TBI regimen using fludarabine (Flu), melphalan (Mel), and low-dose anti-thymocyte globulin (ATG). The median intervals between the failed allo-SCT and salvage CBT, as well as between the diagnosis of PGF and salvage CBT, were 37 days and 8 days, respectively. The median neutrophil recovery period was 21 days (range 18-21 days). Four of five patients achieved neutrophil engraftment following salvage CBT; all four exhibited sustained engraftment with complete donor chimerism. Three of the five patients were alive after a median follow-up time of 907 days (range 315-909 days) post-salvage CBT; two patients died of causes unrelated to recurrence. These data suggest that CBT following the non-TBI regimen described here is feasible in patients with PGF. More... »

PAGES

463-469

References to SciGraph publications

  • 2017-10. Impact of the presence of HLA 1-locus mismatch and the use of low-dose antithymocyte globulin in unrelated bone marrow transplantation in BONE MARROW TRANSPLANTATION
  • 2004-12. Second cord blood transplantation (CBT) with reduced-intensity conditioning for graft failure after the first CBT for AML in BONE MARROW TRANSPLANTATION
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  • 2007-09. Treatment of donor graft failure with nonmyeloablative conditioning of fludarabine, antithymocyte globulin and a second allogeneic hematopoietic transplantation in BONE MARROW TRANSPLANTATION
  • 2012-03. Salvage haploidentical transplantation for graft failure using reduced-intensity conditioning in BONE MARROW TRANSPLANTATION
  • 2014-01. Expansion of donor-reactive host T cells in primary graft failure after allogeneic hematopoietic SCT following reduced-intensity conditioning in BONE MARROW TRANSPLANTATION
  • 2016-07. Feasibility of salvage cord blood transplantation following fludarabine, melphalan and low-dose TBI for graft rejection after hematopoietic stem cell transplantation in BONE MARROW TRANSPLANTATION
  • 2012-05. Outcomes of a 1-day nonmyeloablative salvage regimen for patients with primary graft failure after allogeneic hematopoietic cell transplantation in BONE MARROW TRANSPLANTATION
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  • 2010-12. Graft failure in cord blood transplantation successfully treated with short-term reduced-intensity conditioning regimen and second allogeneic transplantation in INTERNATIONAL JOURNAL OF HEMATOLOGY
  • 2016-04. Impact of low-dose rabbit anti-thymocyte globulin in unrelated hematopoietic stem cell transplantation in INTERNATIONAL JOURNAL OF HEMATOLOGY
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  • 2006-04. Severe regimen-related toxicity of second transplantation for graft failure following reduced-intensity cord blood transplantation in an adult patient in BONE MARROW TRANSPLANTATION
  • 2004-04. Feasibility of reduced intensity hematopoietic stem cell transplantation from an HLA-matched unrelated donor in BONE MARROW TRANSPLANTATION
  • 2009-03. Salvage transplantation for allograft failure using fludarabine and alemtuzumab as conditioning regimen in BONE MARROW TRANSPLANTATION
  • 2012-10. Single-unit umbilical cord blood transplantation from unrelated donors in patients with hematological malignancy using busulfan, thiotepa, fludarabine and ATG as myeloablative conditioning regimen in BONE MARROW TRANSPLANTATION
  • Identifiers

    URI

    http://scigraph.springernature.com/pub.10.1007/s12185-019-02610-4

    DOI

    http://dx.doi.org/10.1007/s12185-019-02610-4

    DIMENSIONS

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    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/30734904


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    46 schema:description Primary graft failure (PGF) is a lethal complication that occurs early after allogeneic stem cell transplantation (allo-SCT). Cord blood transplantation (CBT) is a potential re-transplantation option. Total body irradiation (TBI) is often incorporated into the pre-salvage CBT conditioning regimen following PGF; however, patients experiencing PGF are not always amenable to TBI, and non-TBI regimens for salvage CBT should be established. Here, we report five patients with hematologic malignancies who received salvage CBT for PGF following a non-TBI regimen using fludarabine (Flu), melphalan (Mel), and low-dose anti-thymocyte globulin (ATG). The median intervals between the failed allo-SCT and salvage CBT, as well as between the diagnosis of PGF and salvage CBT, were 37 days and 8 days, respectively. The median neutrophil recovery period was 21 days (range 18-21 days). Four of five patients achieved neutrophil engraftment following salvage CBT; all four exhibited sustained engraftment with complete donor chimerism. Three of the five patients were alive after a median follow-up time of 907 days (range 315-909 days) post-salvage CBT; two patients died of causes unrelated to recurrence. These data suggest that CBT following the non-TBI regimen described here is feasible in patients with PGF.
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