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• W2017268466 abstract "Nonmyeloablative (NM) allogeneic (allo) hematopoietic cell transplantation (HCT) may be effective in patients (pts) at high risk for morbidity and mortality after conventional myeloablative HCT. We report the outcome of NM bone marrow transplantation (BMT) from HLA-matched volunteer unrelated donors (VUDs) in 14 pts (median age 45 yr; range, 19–58) with relapsed and/or refractory hematologic malignancies (1 ALL, 3 AML, 3 MDS/AML, 3 Hodgkin’s disease, 2 multiple myeloma, 2 NHL). Thirteen pts had previous autologous (10 pts) or allo (3 pts) HCT. The NM regimen included alemtuzumab (20 mg/day × 5, days −8 through −4), fludarabine (30 mg/m2/day × 5, days −7 through −3) and melphalan (140 mg/m2 on day −2), as described by Kottaridis PD et al, Blood 2000;96:2419 and Chakraverty R et al, Blood 2002;99:1071. Two pts had primary graft failure (actuarial probability 16.4%; 95% confidence interval[CI] 0–37.6%). In the 12 evaluable pts, median times to ANC >0.5 × 109/L and platelets >20 × 109/L were 15 (range, 9–41) and 21 days (range, 15–41), respectively, after NMBMT. Two pts developed grade I or grade II acute graft-versus-host disease (GVHD) at 19 and 76 days,respectively, after NMBMT. The actuarial probability of grade II or greater GVHD is 9.1% (95% CI 0–26.2%). Two pts developed extensive chronic GVHD, and one of these pts died with chronic GVHD-associated pulmonary failure 267 days after NMBMT. Five pts developed cytomegalovirus (CMV) reactivation, and one of these pts died with CMV infection at 122 days after NMBMT. Six pts died with other infections at a median of 74 days (range, 52–209) after NMBMT: 2 adenovirus (1 associated with graft failure), 2 toxoplasmosis, 1 Aspergillus (associated with graft failure), and 1 Pseudomonas (associated with chronic GVHD). Actuarial nonrelapse mortality (NRM) is 60.0% (95% CI 32.6–87.4%), and infection-associated mortality is 50.0% (95% CI 23.7–76.3%). Three pts relapsed at 181, 182 and 202 days, respectively, after NMBMT; actuarial relapse rate is 37.5% (95% CI 4.0–71.0%). Three pts are alive in remission at 235+, 255+ and 914+ days, respectively, after NMBMT; actuarial event-free survival (EFS) is 14.3% (95% CI 0–37.4%). Opportunistic infection is the major cause of NRM and poor EFS in pts with high-risk hematologic malignancies who undergo VUD NMBMT after alemtuzumab, fludarabine and melphalan. Efforts to improve immune reconstitution and infection prophylaxis after NMBMT with this regimen are warranted." @default.
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• W2017268466 date "2005-02-01" @default.
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• W2017268466 title "Opportunistic infections are the major cause of mortality after nonmyeloablative unrelated bone marrow transplantation with alemtuzumab, fludarabine and melphalan" @default.
• W2017268466 doi "https://doi.org/10.1016/j.bbmt.2004.12.092" @default.
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