TY - JOUR
T1 - The development of a myeloablative, reduced-toxicity, conditioning regimen for cord blood transplantation
AU - Mehta, Rohtesh S.
AU - Di Stasi, Antonio
AU - Andersson, Borje S.
AU - Nieto, Yago
AU - Jones, Roy
AU - De Lima, Marcos
AU - Hosing, Chitra
AU - Popat, Uday
AU - Kebriaei, Partow
AU - Oran, Betul
AU - Alousi, Amin
AU - Rezvani, Katayoun
AU - Qazilbash, Muzaffar
AU - Bashir, Qaiser
AU - Bollard, Catherine
AU - Cooper, Laurence
AU - Worth, Laura
AU - Tewari, Priti
AU - McNiece, Ian
AU - Willhelm, Kaci
AU - Champlin, Richard
AU - Shpall, Elizabeth J.
N1 - Funding Information:
The authors are grateful to the patients and their families. The authors would like to acknowledge our PharmDs, the nursing staff, research coordinators, and cell therapy laboratory staff. This work was supported in part by NCI RO1 CA061508-18 (EJS, SR), CPRIT RO1 RP100469 (EJS, SR), NCI P01 CA148600-02 (EJS, SR, CMB) and Cancer Center Core Grant CA016672 (MD Anderson investigators).
PY - 2014/2
Y1 - 2014/2
N2 - Cord blood transplantation is being used with increasing frequency for patients with high-risk hematologic malignancies. Myeloablative preparative regimens provide antitumor efficacy and facilitate engraftment but are associated with higher morbidity and nonrelapse mortality rates than nonablative regimens. We evaluated 3 sequential myeloablative regimens in the cord blood transplant setting. Regimen 1 (melphalan, fludarabine, and thiotepa) produced prompt engraftment and minimal engraftment failure but was associated with a high nonrelapse mortality rate. Regimen 2 (busulfan and fludarabine) was very well tolerated but was associated with a high rate of engraftment failure and relapse. Regimen 3 (busulfan, clofarabine, fludarabine, and low-dose total body irradiation given 9 days after the chemotherapy) was associated with a low rate of engraftment failure but was logistically difficult to administer. Finally, regimen 3 that included the total body irradiation given immediately after the chemotherapy was well tolerated, with prompt engraftment and tumor control. This latter regimen appears to be effective in preliminary studies and warrants further evaluation.
AB - Cord blood transplantation is being used with increasing frequency for patients with high-risk hematologic malignancies. Myeloablative preparative regimens provide antitumor efficacy and facilitate engraftment but are associated with higher morbidity and nonrelapse mortality rates than nonablative regimens. We evaluated 3 sequential myeloablative regimens in the cord blood transplant setting. Regimen 1 (melphalan, fludarabine, and thiotepa) produced prompt engraftment and minimal engraftment failure but was associated with a high nonrelapse mortality rate. Regimen 2 (busulfan and fludarabine) was very well tolerated but was associated with a high rate of engraftment failure and relapse. Regimen 3 (busulfan, clofarabine, fludarabine, and low-dose total body irradiation given 9 days after the chemotherapy) was associated with a low rate of engraftment failure but was logistically difficult to administer. Finally, regimen 3 that included the total body irradiation given immediately after the chemotherapy was well tolerated, with prompt engraftment and tumor control. This latter regimen appears to be effective in preliminary studies and warrants further evaluation.
KW - Conditioning regimen
KW - Hematologic malignancies
KW - Stem cell transplant
KW - Total body irradiation
KW - Treatment related mortality
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U2 - 10.1016/j.clml.2013.08.006
DO - 10.1016/j.clml.2013.08.006
M3 - Comment/debate
C2 - 24169268
AN - SCOPUS:84892800749
SN - 2152-2650
VL - 14
SP - e1-e5
JO - Clinical Lymphoma, Myeloma and Leukemia
JF - Clinical Lymphoma, Myeloma and Leukemia
IS - 1
ER -