Feasibility of reduced intensity hematopoietic stem cell transplantation from an HLA-matched unrelated donor

E. Kusumi, M. Kami, K. Yuji, T. Hamaki, N. Murashige, A. Hori, R. Kojima, Y. Kishi, S. W. Kim, J. Ueyama, S. Miyakoshi, R. Tanosaki, S. Morinaga, S. Mori, Y. Heike, Y. Muto, S. Masuo, S. Taniguchi, Y. Takaue

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Abstract

To evaluate the feasibility of reduced intensity stem cell transplantation (RIST) with bone marrow from a matched unrelated donor (MUD), we retrospectively investigated 20 patients with hematological disorders who received RIST in the Tokyo SCT consortium from January 2000 to October 2002. The preparative regimens were fludarabine-based (150-180 mg/m2, n = 18) or cladribine-based (0.77 mg/kg, n = 2). To enhance engraftment, antithymocyte globulin (ATG) and 4 or 8 Gy total body irradiation (TBI) were added to these regimens in nine and 11 patients, respectively. GVHD prophylaxis was cyclosporine with or without methotrexate. In all, 19 achieved primary engraftment. Three developed graft failure (one primary, two secondary), and five died of treatment-related mortality within 100 days of transplant. Seven of the 19 patients who achieved initial engraftment developed grade II-IV acute GVHD, and seven of 13 patients who survived >100 days developed chronic GVHD. At a median follow-up of 5.5 months, estimated 1-year overall survival was 35%. Compared with a TBI-containing regimen, an ATG-containing regimen was associated with a high risk of graft failure (30 vs 0%, P = 0.0737). This study supports the feasibility of RIST from MUD; however, procedure-related toxicities remain significant in its application to patients.

Original languageEnglish
Pages (from-to)697-702
Number of pages6
JournalBone Marrow Transplantation
Volume33
Issue number7
DOIs
Publication statusPublished - 2004 Apr 1
Externally publishedYes

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Keywords

  • Antithymocyte globulin
  • Intermediate-dose TBI
  • Matched unrelated donors
  • RIST

ASJC Scopus subject areas

  • Hematology
  • Transplantation

Cite this

Kusumi, E., Kami, M., Yuji, K., Hamaki, T., Murashige, N., Hori, A., Kojima, R., Kishi, Y., Kim, S. W., Ueyama, J., Miyakoshi, S., Tanosaki, R., Morinaga, S., Mori, S., Heike, Y., Muto, Y., Masuo, S., Taniguchi, S., & Takaue, Y. (2004). Feasibility of reduced intensity hematopoietic stem cell transplantation from an HLA-matched unrelated donor. Bone Marrow Transplantation, 33(7), 697-702. https://doi.org/10.1038/sj.bmt.1704425