PMID- 11008023
OWN - NLM
STAT- MEDLINE
DCOM- 20001030
LR  - 20191025
IS  - 0301-472X (Print)
IS  - 0301-472X (Linking)
VI  - 28
IP  - 9
DP  - 2000 Sep
TI  - Second allogeneic stem cell transplantation using nonmyeloablative conditioning 
      for patients who relapsed or developed secondary malignancies following 
      autologous transplantation.
PG  - 1096-104
AB  - OBJECTIVE: Second allogeneic stem cell transplants for hematological malignancies 
      are associated with a high incidence of transplant-related mortality due to the 
      cumulative incidence of toxicity of the high-dose chemoradiotherapy traditionally 
      used as an essential component of the conditioning. We have demonstrated 
      previously that nonmyeloablative conditioning for primary allogeneic transplants 
      from both sibling and unrelated donors results in minimal transplant-related 
      toxicity and excellent stem cell engraftment. This study explores the possibility 
      of using nonmyeloablative conditioning to minimize transplant-related toxicity in 
      patients who have undergone second allogeneic transplants. PATIENTS AND METHODS: 
      Twelve high-risk, heavily treated patients-five with acute myelogenous leukemia 
      (AML); five with non-Hodgkin's lymphoma (NHL); one with Burkitt's lymphoma, and 
      one with acute lymphoblastic leukemia (ALL)-underwent second allogeneic 
      nonmyeloablative stem cell transplantation (NST) from human leukocyte antigen 
      (HLA)-matched donors, 29 (median) (range 3-57) months following their first 
      transplantation procedure. The conditioning consisted of fludarabine 30 mg/m(2) 
      daily for 6 days, busulfan 4 mg/kg daily for 2 days, and anti-T-lymphocyte 
      globulin 10 mg/kg daily for 4 days. Anti-graft-vs-host disease (anti-GVHD) 
      prophylaxis consisted of cyclosporine A alone, 3 mg/kg. RESULTS: Engraftment was 
      observed in all recipients, with complete and stable chimerism. None of the 
      patients developed veno-occlusive disease of the liver or multi-organ failure. 
      Five very high-risk patients with NHL (n = 3), Burkitt's lymphoma (n = 1), and 
      AML (n = 1) relapsed 2 to 6 months post-transplant, and four of them died. Six 
      patients appear to be disease-free after median follow-up of 23 months. One 
      additional patient died from grade IV hemorrhagic cystitis. Actuarial survival 
      and disease-free survival at 34 months are 56% and 50% respectively, with 95% 
      confidence interval (25-78%). CONCLUSION: These results suggest that 
      nonmyeloablative conditioning significantly reduces transplant-related toxicity, 
      thus making a second transplant feasible.
FAU - Nagler, A
AU  - Nagler A
AD  - The Department of Bone Marrow Transplantation & The Cancer Immunotherapy & 
      Immunobiology Research Center, Hadassah University Hospital, The Hebrew 
      University-Hadassah School of Medicine, Jerusalem, Israel. Nagler@hadassah.org.il
FAU - Or, R
AU  - Or R
FAU - Naparstek, E
AU  - Naparstek E
FAU - Varadi, G
AU  - Varadi G
FAU - Slavin, S
AU  - Slavin S
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - Netherlands
TA  - Exp Hematol
JT  - Experimental hematology
JID - 0402313
SB  - IM
MH  - Actuarial Analysis
MH  - Adolescent
MH  - Adult
MH  - Animals
MH  - Cause of Death
MH  - Child
MH  - Disease-Free Survival
MH  - Female
MH  - Graft Survival
MH  - Graft vs Host Disease/drug therapy/pathology
MH  - Graft vs Tumor Effect
MH  - Hematologic Neoplasms/complications/therapy
MH  - Hematopoietic Stem Cell Transplantation/adverse effects/*methods
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Neoplasms, Second Primary/complications/*therapy
MH  - Recurrence
MH  - Survival Rate
MH  - Transplantation Chimera
MH  - Transplantation Conditioning/adverse effects/*methods
MH  - Transplantation, Autologous/adverse effects
MH  - Transplantation, Homologous
MH  - Treatment Outcome
EDAT- 2000/09/29 11:00
MHDA- 2001/02/28 10:01
CRDT- 2000/09/29 11:00
PHST- 2000/09/29 11:00 [pubmed]
PHST- 2001/02/28 10:01 [medline]
PHST- 2000/09/29 11:00 [entrez]
AID - S0301-472X(00)00511-7 [pii]
AID - 10.1016/s0301-472x(00)00511-7 [doi]
PST - ppublish
SO  - Exp Hematol. 2000 Sep;28(9):1096-104. doi: 10.1016/s0301-472x(00)00511-7.