TY - JOUR
T1 - Fludarabine, melphalan, thiotepa and anti-thymocyte globulin conditioning for unrelated cord blood transplant
AU - Ciurea, Stefan O.
AU - Saliba, Rima M.
AU - Hamerschlak, Nelson
AU - Karduss Aurueta, Amado J.
AU - Bassett, Roland
AU - Fernandez-Vina, Marcelo
AU - Petropoulos, Demetrios
AU - Worth, Laura L.
AU - Chan, Ka Wah
AU - Couriel, Daniel R.
AU - Rondon, Gabriela
AU - Sharma, Manish
AU - Qazilbash, Muzaffar
AU - Jones, Roy B.
AU - Kebriaei, Partow
AU - McMannis, John
AU - Hosing, Chitra M.
AU - Nieto, Yago
AU - Champlin, Richard E.
AU - Shpall, Elizabeth J.
AU - De Lima, Marcos
PY - 2012/5
Y1 - 2012/5
N2 - Unrelated cord blood transplant (CBT) is an alternative treatment option for patients who lack a matched donor. However, the optimal type and intensity of the preparative regimen remains unclear. We evaluated the toxicity and outcomes of a conditioning regimen consisting of melphalan 140 mg/m 2 (day - 8), thiotepa 10 mg/kg (day - 7), fludarabine 160 mg/m 2 over 4 days (days - 6 to - 3) and rabbit antithymocyte globulin (ATG) 1.25 mg/kg (day - 4) and 1.75 mg/kg (day - 3) (FMT). Forty-seven patients with advanced hematologic malignancies with a median age of 23 years (30 adults and 17 children) were treated. Sixty percent of patients were in remission at transplant. Ninety-one percent of the patients engrafted neutrophils after a median of 22 days, and all but one of the patients achieving donor engraftment had hematopoietic recovery with 100% cord blood-derived cells. Grade 3 gastrointestinal toxicity was the major non-hematopoietic toxicity, occurring in 32% of patients. Cumulative incidence of day-100 grade IIIV acute graft-versus-host disease (aGVHD) and chronic graft-versus-host disease (cGVHD) was 53% and 34%, respectively, and non-relapse mortality at day 100 and 2 years was 11% and 40%. Two-year disease-free and overall survival rates were 31% and 44%, respectively. These results suggest that FMT is a feasible conditioning regimen for patients undergoing CBT.
AB - Unrelated cord blood transplant (CBT) is an alternative treatment option for patients who lack a matched donor. However, the optimal type and intensity of the preparative regimen remains unclear. We evaluated the toxicity and outcomes of a conditioning regimen consisting of melphalan 140 mg/m 2 (day - 8), thiotepa 10 mg/kg (day - 7), fludarabine 160 mg/m 2 over 4 days (days - 6 to - 3) and rabbit antithymocyte globulin (ATG) 1.25 mg/kg (day - 4) and 1.75 mg/kg (day - 3) (FMT). Forty-seven patients with advanced hematologic malignancies with a median age of 23 years (30 adults and 17 children) were treated. Sixty percent of patients were in remission at transplant. Ninety-one percent of the patients engrafted neutrophils after a median of 22 days, and all but one of the patients achieving donor engraftment had hematopoietic recovery with 100% cord blood-derived cells. Grade 3 gastrointestinal toxicity was the major non-hematopoietic toxicity, occurring in 32% of patients. Cumulative incidence of day-100 grade IIIV acute graft-versus-host disease (aGVHD) and chronic graft-versus-host disease (cGVHD) was 53% and 34%, respectively, and non-relapse mortality at day 100 and 2 years was 11% and 40%. Two-year disease-free and overall survival rates were 31% and 44%, respectively. These results suggest that FMT is a feasible conditioning regimen for patients undergoing CBT.
KW - Unrelated cord blood transplant
KW - fludarabine
KW - melphalan
KW - reduced-intensity conditioning
KW - thiotepa
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U2 - 10.3109/10428194.2011.631159
DO - 10.3109/10428194.2011.631159
M3 - Article
C2 - 21988645
AN - SCOPUS:84859970110
SN - 1042-8194
VL - 53
SP - 901
EP - 906
JO - Leukemia and Lymphoma
JF - Leukemia and Lymphoma
IS - 5
ER -