Intensive graft-versus-host disease prophylaxis is required after unrelated-donor nonmyeloablative stem cell transplantation View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2005-05

AUTHORS

A W Loren, S M Luger, E A Stadtmauer, D E Tsai, S Schuster, S D Nasta, S C Goldstein, A Perl, G Orloff, J C Oliver, J Green, S G Emerson, D L Porter

ABSTRACT

Nonmyeloablative stem cell transplantation (NST) harnesses the graft-versus-tumor effect while minimizing regimen-related toxicity, and can result in donor chimerism and remission. Acute graft-versus-host disease (GVHD) and infections are major complications after sibling NST. Toxicity of unrelated-donor (UD) NST and the most appropriate GVHD prophylaxis in this setting remain poorly defined. We describe 25 patients who received UD-NST conditioned with fludarabine and cyclophosphamide. The first six patients received cyclosporine (Cs) and mycophenolate mofetil (MMF) (n=5) or methotrexate (MTX) (n=1) as GVHD prophylaxis (group 1) and all developed grade III-IV acute GVHD. The next 19 patients received the same conditioning regimen with the addition of alemtuzumab, and all received Cs/MTX post-transplant. Engraftment and donor chimerism were achieved in all but one evaluable patient. In all, 15 patients died: five of six deaths in group 1 were attributable to acute GVHD, while deaths in group 2 were due to infection or progressive disease (P=0.05). The combination of Cs/MMF is inadequate GVHD prophylaxis for UD-NST. The use of Cs, MTX, and alemtuzumab eliminated severe acute GVHD; its impact on response merits further study. More... »

PAGES

921

Identifiers

URI

http://scigraph.springernature.com/pub.10.1038/sj.bmt.1704887

DOI

http://dx.doi.org/10.1038/sj.bmt.1704887

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1030633413

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/15765118


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